术前肠内营养对老年乳腺癌患者围术期肠黏膜屏障功能、免疫功能和营养状况的影响

Effect of preoperative enteral nutrition on intestinal mucosal barrier, immune function and nutritional status in elderly patients with breast cancer during perioperative period

目的探究术前肠内营养对老年乳腺癌患者围术期肠黏膜屏障功能、免疫功能和营养状况的影响。方法将本院2014年8月至2017年10月收治的106例老年女性乳腺癌患者纳入本研究。采用随机数表法将入选患者分为观察组和对照组,每组各53例。两组患者术前均给予常规治疗和饮食干预,观察组患者在此基础上联合肠内营养支持治疗。比较两组患者干预前和术后7 d肠黏膜屏障功能、免疫功能和营养状况。结果观察组患者术后7 d血清降钙素原和D-乳酸水平均显著低于本组干预前和同期对照组(均P < 0.05)。对照组患者术后7 d血清降钙素原和D-乳酸水平均显著高于本组干预前(均P < 0.05),血清免疫球蛋白G、免疫球蛋白A、免疫球蛋白M、总蛋白、白蛋白水平和总淋巴细胞计数均显著低于本组干预前和同期观察组(均P < 0.05)。观察组患者干预前和术后7 d免疫球蛋白G、免疫球蛋白A、免疫球蛋白M、血清总蛋白和白蛋白水平比较差异均无统计学意义(均P > 0.05)。两组患者干预前和术后7 d心理状态均无明显变化(均P > 0.05),且组间比较差异均无统计学意义(均P > 0.05)。结论术前肠内营养能够改善老年乳腺癌患者术后肠黏膜屏障功能,减轻手术创伤,改善应激所致免疫功能和营养状况变化,有望缩短患者住院天数、促进其早日康复,值得临床推广。

Objective To explore the effect of preoperative enteral nutrition on intestinal mucosal barrier, immune function and nutritional status in elderly patients with breast cancer during perioperative period. Method 106 female elderly patients with breast cancer admitted to our hospital from August 2014 to October 2017 were included in this study. Both group patients were divided into observation group and control group by random number table method, 53 cases in each group. All patients were given routine treatment and dietary intervention before operation. Observation group patients were given enteral nutrition support. The changes of intestinal mucosal barrier function index, immune index and nutritional index before intervention and 7 days after operation were compared between the two groups. Result 7 days after operation, the serum procalcitonin and D-lactic acid levels in observation group were significantly lower than those before intervention and control group at the same time (all P < 0.05). The levels of serum procalcitonin and D-lactic acid in control group were significantly higher than those before intervention (all P < 0.05), the levels of serum immunoglobulin G, immunoglobulin A, immunoglobulin M, total protein, albumin and total lymphocyte count were significantly lower than those before intervention and observation group at the same time (all P < 0.05). There were no significant differences in immunoglobulin G, immunoglobulin A, immunoglobulin M, serum total protein and albumin levels before intervention and 7 days after operation in observation group (all P > 0.05). There were no significant differences in mental state between the two groups before intervention and 7 days after operation (all P > 0.05), and there were no significant differences between the two groups (all P > 0.05). Conclusion Preoperative enteral nutrition can improve the intestinal mucosal barrier function of elderly patients with breast cancer after operation, alleviate the changes of immune function and nutritional status caused by surgical trauma, stress, and hopefully shorten the hospitalization time of patients and promote early recovery, which is worthy of promotion.