营养风险胃癌患者围术期免疫营养支持的临床研究

Clinical application on perioperative immunonutrition support in gastric cancer patients with nutritional risk

目的观察围术期免疫营养支持对营养风险胃癌患者术后营养状况和恢复状况的影响,探讨围术期免疫营养支持对胃癌患者加速康复治疗的辅助作用。方法筛选营养风险患者56例,分为围术期免疫营养支持组(IN组,n=28)、围术期常规营养支持组(GN组,n=28)。IN组术前7 d起,每天口服肠内免疫营养乳剂至术后第7天(手术日除外);GN组术前7 d起每天口服肠内普通营养乳剂至术后第7天(手术日除外)。2组患者于术后第1天和第8天检测营养指标、炎症指标、免疫指标及临床指标。结果营养指标比较,术后第1天,IN组PA高于GN组(P<0.05),ALB差异无统计学意义(P>0.05),术后第8天,IN组PA、ALB高于GN组(P<0.05)。炎症指标比较,术后第1天,IN组TNF-α、IL-6、CRP低于GN组(P<0.05);术后第8天,IN组TNF-α、IL-6低于GN组(P<0.05),CRP差异无统计学意义(P>0.05)。免疫指标比较,术后第1天,IN组IgG、IgM、IgA水平高于GN组(P<0.05);术后第8天,IN组IgG、IgA高于GN组(P<0.05),IgM差异无统计学意义(P>0.05)。临床指标比较,IN组并发症发生率较GN组低(P<0.05);IN组肛门排气时间较GN组提前(P<0.05)。结论围术期免疫营养支持显著减低手术应激炎症反应,改善营养状况对胃癌患者加速康复外科具有辅助作用。

Objective To observe the effect of perioperative immunonutrition support on nutritional status and recovery status in gastric cancer patients with nutritional risk. To discuss the auxiliary role of the Enhanced Recovery After Surgery（ERAS） that periop- erative immunonutrition support in gastric cancer patients. Methods Fifty - six gastric cancer patients with nutritional risk were selected and randomly divided into perioperative immunonutrition support group （ IN group, n = 28 ） and general nutrition support group （ GN group, n = 28 ）. Patients of IN were given the enteral immune nutrient from preoperative 7th day to postoperative 7th day（ except the oper- ation day）. Patients of GN group were given the enteral general nutrient from preoperative 7th day to postoperative 7th day （ except the operation day）. The levels of nutrition status, stress status, immune function and clinical status were detected on postoperative 1 th and 8th day. Results Nutritional indexes ： On postoperative 1 th day, PA in IN group were higher than that in GN group （ P 〈 0.05 ）, but no difference in ALB （ P 〉 0.05 ）. On postoperative 8th day, PA and ALB in IN group were higher than those in GN group （ P 〈 0.05 ）. In- flammatory indexes：On postoperative 1 th day, TNF -α, IL -6 and CRP in IN group were lower than those in GN group （P 〈 0.05 ） ; On postoperative 8th day ,TNF-α and IL- 6 in IN group were lower than those in GN group（ P 〈 0.05 ）, but there were no difference be- tween each group on the serum levels of CRP （ P 〉 0.05 ）. Immunological indexes ： On postoperative 1 th day, IgG, IgM, IgA in IN group were higher than those in GN group（P 〈 0.05） ;On postoperative 8th day, the level of IgM were no difference between each group, the level of IgG and IgA in IN group were higher than those in GN group （P 〈0.05）. Clinical indexes：6 patients had postoperative compli- cations in IN group （17.9%）,while as 10 patients had postoperative complications in GN group （42.9%）. Anal exhaust time in IN group was earlier than that in GN group （P 〈 0.05）. Conclusion Perioperative immunonutrition support in gastric cancer patients can improve the patientg ability to tolerate surgery better, reduce surgical stress and lower systemic inflammatory reaction, accelerate postoper- ative recovery, which can give play auxiliary role to the idea of ERAS of gastric cancer patients.