胃癌全胃切除患者围术期两种免疫营养支持治疗的临床比较

Perioperative immunonutrition for patients with gastric carcinoma undergoing total gastrectomy

目的比较胃癌全胃切除患者围术期两种免疫营养支持治疗的效果。方法将接受全胃切除的胃癌患者随机分为围术期免疫营养(PIN)组60例,术前5d给予肠外免疫营养支持治疗,术后早期给予肠内免疫营养支持治疗1周;术后早期肠内免疫营养(EIN)组60例,仅在术后早期给予肠内免疫营养支持治疗1周。比较两组患者术前及术后第1、7、10天营养指标(总蛋白、白蛋白、前清蛋白、转铁蛋白、氮平衡)、免疫功能指标(IgG、IgA、IgM、CD3^+、CD4^+、CD4^+/CD8^+)的情况及术后感染性并发症(包括肺部感染、尿路感染、切口感染)的发生率。结果 PIN组患者术前及术后第1天在提高患者营养指标,纠正免疫功能指标等方面较EIN组有效,差异均有统计学意义(均P<0.05),且PIN组术后感染性并发症的发生率低于EIN组(P<0.05)。结论胃癌全胃切除患者围术期应用免疫营养支持治疗较单纯术后早期应用,更能改善患者的营养状况,纠正免疫功能,减少术后并发症的发生。

Objective TO investigate the clinic effect of perioperative immunonutrition（PIN） for patients with gastric carcinoma undergoing total gastrectomy. Methods One hundred and twenty patients with gastric carcinoma who underwent total gastrectomy during January 2012 and June 2014 in Hangzhou First People＇s Hospital were randomly divided into 2 groups： 60 patients in PIN group received parenteral immunonutrition support for 5d before operation and then enteral immunonutrition treatment for lw after surgery; 60 patients in EIN （early enteral immunonutrition） group received enteral immunonutirtion treatment for lw after surgery only. Nutrient status and immune function of these two groups were examined on the preoperative dl, postoper- ative dl, 7 and 10. The rate of postoperative infective complications were also documented. Results The indexes of nutrient status, immune function and nitrogen balance in PIN group were better than those in EIN group on preoperative dl and postoper- ative dl（P〈0.05）. The rate of postoperative infective complication in PIN group was lower than that in EIN group（P〈0.05）. Con- clusion Perioperative immunonutrition is safe and effective for patients with gastric carcinoma undergoing gastrectomy, with better nutritional status and immune function, and less postoperative infective complications.