术前肠内营养对食管癌围手术期营养状态、免疫功能与应激反应的影响

The effects of preoperative enteral nutrition on peri-operative nutritional status,immune function and stress response in patients with esophagus cancer

目的:探讨术前肠内营养对食管癌围手术期营养状态、免疫功能与应激反应的影响。方法:选取2015年1月至2016年12月,入住我科食管癌病人96例,随机双盲分为试验组(肠内营养制剂组)与对照组,其中每组48例。试验组术前7 d通过口服或鼻胃管,按30 kcal/kg/d的能量要求,给予肠内营养制剂,持续7 d。对照组,为普通饮食。两组病人术后均继续予以肠内营养制剂肠内营养7 d。对比两组病人围手术期营养、免疫及炎症指标的变化。结果:术前8 d,两组病人的营养、免疫和炎症指标比较无显著性差异。术前1 d,试验组PA、ALB、TF均显著高于对照组(P<0.05)。Ig G、CD4/CD8均显著高于对照组(P<0.05)。CRP显著低于对照组(P<0.05)。术后第8 d,试验组,PA、ALB、TF均显著高于对照组(P<0.05)。Ig G、CD4/CD8均显著高于对照组(P<0.05)。CRP显著低于对照组(P<0.05)。试验组的肺部感染和吻合口瘘的发生率均显著低于对照组(P<0.05)。结论:术前肠内营养能明显改善食管癌病人围手术期的营养状态、增强免疫功能及降低应激反应。

Objective： To determine the effects of preoperative enteral nutrition on peri-operative nutritional status, immune function and stress response in patients with esophagus cancer. Methods： From January 2015 to December 2016, 96 patients with esophageal cancer were divided into intervention group（preoperative enteral nutrition group） and control group randomly, with 48 cases in each group. The intervention group was treated with enteral nutrition for consecutive 7 days before surgical operation on the basis of energy requirements of 30 kcal/kg/d by oral or nasogastric tube. The control group was treated with regular diet. Both groups were treated with enteral nutrition for 7 days by nasojejunal tube during post-operative 7 days.The peri-operative nutritional status, immune function and inflammatory indexes in the two groups were observed and compared. Results： At baseline, there was no significant difference in nutritional, immune and inflammatory markers between the two groups. After preoperative enteral nutrition intervention, the serum levels of PA、ALB、TF in the intervention group were significantly higher than those in the control group（all P〈0.05）.What＇s more, The levels of Ig G and CD4/CD8 ratio in the intervention group were remarkably higher than those in the control group（P〈0.05）.In addition, the serum level of CRP in intervention group was significantly reduced in contrast to the control group（P〈0.05）.After post-operative enteral nutrition intervention, the serum levels of PA、ALB、TF as well as Ig G and CD4/CD8 ratio of the intervention group were greatly improved, the level of CRP was obviously reduced in comparison with the control group（P〈0.05）. Furthermore, the incidences of pneumonia and anas tomotic fistula evidently decreased in the intervention group（all P〈0.05）. Conclusion： Preoperative enteral nutrition could significantly improve the perioperative nutritional status, enhance immune function and reduce stress response in patients with esophageal cancer.