精氨酸强化低热量肠外营养支持在胃肠癌术后的应用

Postoperative use of arginine-enriched hypocaloric parenteral nutrition in gastrointestinal cancer patients.

目的 探讨胃肠癌根治术后应用精氨酸强化低热量肠外营养的营养、免疫作用及其对术后疲劳的影响。方法 40 8例胃肠癌根治术后病人分为 3组 ,术后第 1天开始分别给予 3种不同方案的肠外营养支持 5～ 7天。其中低热量肠外营养组 (HPN组 ) 3 5 2例 ,精氨酸强化低热量肠外营养组 (Arg组 )组 3 0例 ,对照组 2 6例。术前及术后第 8天检测多项营养和免疫指标 ,并评估病人手术前后的疲劳程度。结果 胃肠癌根治术后HPN具有明显的营养效应。精氨酸强化HPN改善了病人的营养与免疫状况 ,使术后感染率从 2 3 %降低至 10 % ,并改善了术后疲劳程度 (P <0 0 5 )。结论 精氨酸强化HPN既有明显的营养作用 ,又有免疫调节作用 。

Objective To evaluate the effects of arginine-enriched hypocaloric parenteral nutrition(HPN) on improving the nutritional status, the immune function,and the postoperative fatigue(POF) in gastrointestinal cancer patients undergoing radical surgery. Methods Four hundred and eight patients who underwent radical operation for gastrointestinal cancer were allocated into 3 groups,352 patients in HPN group, 30 in arginine-enriched HPN (Arg-HPN) group,and 26 in control group. The three different types of nutritional support formula were used,respectively, to the patients by central vein for 5 ～ 7 days from the first day after operation. In the study,the nutritional and immunological indices were investigated. A visual analog scale was used to estimate the subjective feeling of fatigue. These parameters were evaluated preoperatively and on the 8th day after operation.Results HPN had significant nutritional effect in gastroinstestinal cancer patients undergoing radical surgery.Arg HPN improved the nutritional status and the immune status.There were significant differences between Arg HPN and HPN group ,in the rate of postoperative infection(10% vs 23%) and score of POF (P<0 05).Conclusion Arg HPN can not only improve the nutritional status and the immune function obviously,but also decrease the score of POF for the patients who underwent radical operation for gastrointestinal cancer.