结直肠癌患者术后早期经口肠内营养对免疫功能的影响

Clinical analysis of early postoperative oral enteral nutritionon immune function for colorectal cancer patients

目的探讨结直肠癌患者术后早期经口肠内营养对术后恢复及免疫功能影响，为临床诊治提供参考。方法选择90例结直肠癌手术治疗患者，采用随机数字表法将患者分为观察组与对照组，观察组50例患者术后早期经口肠内营养支持，对照组40例患者术后行肠外营养支持。对比两组患者治疗前后生活质量、并发症、免疫学指标、营养指标等。结果观察组术后发热时间、排气时间、住院时间、住院费用、生存质量评分分别为（54．29±5．76）h、（57．89±5．95）h、（10．48±1．63）d、（41432．85±2165．46）元、（79．23±5．17）分，均明显低于对照组（t=8．69，P=0．00；t=8．61，P=0．00；t=9．49，P=0．00；t=5．54，P=0．00；t：4．16，P=0．01）；术后7d观察组IgA、IgG、IgM、CD4^＋、CD46＋／CD8^＋分别为（1．92±0．49）g/L、（11．31±2．24）g／L、（0．99±0．21）g／L、（41．21±5．51）％、（1．72±0．32），均优于对照组（t=2．05，P=0．04；t=2．11，P=0．04；t=2．12，P=0．04；t=3．64，P=0．01；t=2．23，P=0．03）；观察组术后7d血红蛋白（Hb）、转铁蛋白（TRF）、白蛋白（ALB）、血清前白蛋白（PAB）分别为（113．28±13．36）g/L、（3．02±0．39）mg／L、（38．97±3．15）g／L、（333．15±18．35）mg／L，均优于对照组（t=3．45，P=0．01；t=2．18，P=0．03；t=2．32，P=0．04；t=3．21，P=0．01）；观察组术后7dCRP为（7．29±2．05）ms／L，明显低于对照组，差异有统计学意义（t=4．22，P=0．01）；观察组术后并发症发生率为26．00％，对照组术后并发症发生率为40．00％，两组差异有统计学意义（Х^2=4．52，P=0．01）。结论结直肠癌患者术后早期经口肠内营养支持利于改善免疫功能，加强营养支持，降低炎性反应，利于术后恢复。

Objective To investigate clinical effects of early postoperative oral enteral nutrition on immune function for colorectal cancer patients, to provide a reference for clinical treatment. Methods, We selected 90 colorectal cancer surgery patients from January 2012 to April 2015 ,and they were divided into two groups by random number method. 50 cases in the study group were given early oral enteral nutrition, and 40 patients in the control group were given postoperative parenteral nutrition. Before and after treatment ,the quality of life, complications, immunology indicators,nutrition indicators were compared in two groups. Results In the observation group, the postoperative fever, exhaust time, hospital stay, hospital costs, quality of life scores were （ 54.29 ± 5.76） h, （ 57.89 ± 5.95 ） h, （ 10.48 ± 1.63 ）d, （41 432.85 ± 2 165.46）RMB, （79.23 ± 5.17 ）points ,which were significantly lower than those in the control group, the differences were statistically significant （t = 8.69, P = 0. 00 ; t = 8.61, P = 0. 00 ; t = 9.49, P = 0.00 ; t=5.5g,P=0. 00;t =4. 16,P =0.01）;Td after the treatment,the IgA,IgG,IgM,CD4^＋ , CD4^＋/CD8^＋ in observation group were （1.92 ＋0.49）g/L, （11.31 ±2.24）g/L,（0.99 ±0.21）g/L,（41.21 ±5.51）% ,（1.72 ±0.32）,which were better than those in the control group, the differences were statistically significant （ t = 2.05, P = 0.04 ; t = 2.11, P = 0.04 ; t = 2.12, P = 0. 04 ; t = 3.64, P = 0.01 ; t = 2.23, P = 0.03 ）. In observation group, postoperative 7 d Hb, TRF,ALB,PAB were （113.28 ±13.36）g/L, （3.02 ±0.39） mg/L, （38.97 ±3.15） g/L, （333.15 ±18.35） mg/L, which were better than those in the control group, the differences were statistically significant （t = 3.45, P = 0. 01 ;t = 2.18, P = 0. 03 ; t = 2.32, P = 0.04 ; t = 3.21, P = 0. 01 ）. 7 d after operation, the CRP level of.observation group was （7.29± 2.05 ） mg/L, which was significantly lower than that of the control group, the difference was statistically significant （ t = 4. 22, P = 0. 01 ）. The incidence rate of postoperative complications in the observation group was 26.00% ,that of the control group was 40.00%,the difference was statistically significant （Х^2 =4.52,P =0.01 ）. Conclusion Early oral enteral nutrition in patients with colorectal cancer will help to improve immune function, nutritional support, reduce the inflammatory response, which will help postoperative recovery.