肝胆手术后肠内营养与肠外营养支持对患者炎性因子与免疫学指标的影响

Effects on inflammatory factors and immune indexes between enteral nutrition and parenteral nutrition support in hepatobiliary surgery patients

目的比较肠内营养(EN)和肠外营养(PN)对肝胆外科手术患者术后炎性应激和免疫功能的影响。方法回顾性分析2012年1月-2016年6月行胰十二指肠切除术和肝脏切除术的196例患者病例资料;其中术后行EN支持102例,行PN支持94例。比较两组术后1d、7d外周血炎性因子和免疫学指标变化及术后并发症发生率。结果术后7d,两组患者外周血炎性因子均较术后1d下降,EN组下降数值显著高于PN组[TNF-α:(62.9±19.5)vs(89.3±21.8)ng/L,IL-6:(15.8±4.0)vs(19.3±4.9)ng/L,IL-8:(35.4±10.3)vs(39.7±11.8)ng/L,CRP:(20.6±4.7)vs(23.5±5.2)mg/L](P均<0.05)。术后7d,两组患者免疫球蛋白、CD+3、CD+4/CD+8均较术后1d上升,EN组上升数值均显著高于PN组[IgA:(0.32±0.08)vs(0.48±0.11)g/L,IgG:(1.33±0.37)vs(2.03±0.53)g/L,IgM:(0.17±0.06)vs(0.21±0.10)g/L,CD+3:(5.78±1.61)vs(6.81±1.92)%,CD+4/CD+8:(0.40±0.08)vs(0.47±0.12)](P均<0.05);PN组并发症发生率高于EN组[腹泻(17.0%vs 4.9%)、腹胀(22.3%vs 10.8%)、切口感染(11.7%vs 3.8%)、置管处静脉炎(5.3%vs 0)](P均<0.05);EN组便秘(3.9%vs 0)、吻合口瘘发生率(4.9%vs 4.3%)高于PN组(P均>0.05)。结论肝胆外科手术术后行EN支持较PN支持在减轻炎性应激、改善免疫抑制、降低并发症发生率方面具有比较优势。

Objective To compare the effects on variations of peripheral inflammatory factor and immunological indexes between enteral nutrition(EN)and parenteral nutrition(PN)support in hepatobiliary surgery patients.Methods A retrospective analysis was conducted among 196 cases underwent pancreaticoduodenectomy and liver resection from January 2012 to June 2016,of which 102 cases with postoperative EN support,and 94 cases with PN support.Variations of postoperative peripheral blood inflammatory factors and immune indexes,as well as the occurrences of complications was measured and compared between the two groups 1 dand 7 dafter surgery.Results The seventh days after operation,the peripheral blood inflammatory factors decreased for both two groups compared with that of postoperative 1 d,the decrease in EN group was significantly higher than that of the PN group[TNF-α(62.9±19.5 vs.89.3±21.8)ng/L,IL-6(15.8±4.0 vs.19.3±4.9)ng/L,IL-8(35.4±10.3 vs.39.7±11.8)ng/L,CRP(20.6±4.7 vs.23.5±5.2)mg/L](all P<0.05).The immunoglobulin,CD3+,CD4+/CD8+7 dpost-operation increased for two group compared with postoperative 1 d,The increase in EN group was significantly higher than that of the PN group[Ig A(0.32±0.08 vs.0.48±0.11)g/L,IgG(1.33±0.37 vs.2.03±0.53)g/L,IgM(0.17±0.06 vs.0.21±0.10)g/L,CD3+(5.78±1.61 vs.6.81±1.92)%,CD4+/CD8+(0.40±0.08 vs.0.47±0.12)](all P<0.05);PN group with incidences of diarrhea(17.0% vs.4.9%),abdominal distension(22.3% vs.10.8%),incision infection(11.7% vs.3.8%),catheter phlebitis(5.3% vs 0)were significantly higher than that of the EN group(P<0.05);EN group with incidences of constipation(3.9% vs 0),anastomotic leakage(4.9% vs.4.3%)were higher than that of the PN group,there was no statistical significance(P >0.05).Conclusion Hepatobiliary surgery patients underwent EN postoperative support is advantageous in reducing inflammatory stress,improving immune suppression and reducing complications compared with PN support.