消化道肿瘤术后早期应用免疫增强型肠内营养的作用

Effects of early postoperative immune-enhancing enteral nutrition in gastrointestinal cancer patients.

目的 评价免疫增强型肠内营养制剂对肿瘤病人手术创伤后代谢 ,炎性反应 ,免疫功能及预后的影响。方法 88例消化道恶性肿瘤手术病人随机分为常规肠内营养组和免疫增强型肠内营养组。手术后第 1天开始等热量、等氮肠内营养支持 1周。于术前、术后第 1、4天和研究结束时分别检测多核白细胞的吞噬功能、氧化代谢情况 ,巨噬细胞NO产生量 ,IL 1、IL 2、IL 6及TNF α浓度 ,IgA、IgG、IgM ,淋巴细胞总数 ,T、B淋巴细胞数及CD4 、CD8,血清PGE2 浓度 ,CRP、α 抗胰蛋白酶和纤维蛋白原等急性相反应蛋白浓度。检测总蛋白 ,白蛋白等 ,前白蛋白、转铁蛋白及氮平衡等营养指标。同时观测研究期间病死率 ,手术后感染性并发症发生率及住院时间。结果 研究结束时 ,研究组IgA、IgG、IgM ,血淋巴细胞总数、CD3、CD4 及CD4 /CD8、多核白细胞的吞噬能力、多核白细胞的氧化代谢状况及巨噬细胞的NO产生量均明显高于对照组 (P <0 0 1) ;而血IL 6、TNF α浓度及CRP水平明显低于对照组 (P <0 0 5 )。研究期间两组白蛋白 ,每日及累积氮平衡差异无显著性 ,术后第 8天 ,研究组血浆前白蛋白及转铁蛋白浓度明显高于对照组。两组在术后 4天内的感染性并发症发生率差异无显著意义 ,但研究组术后 4天以后的感染性并发症发生率却明显低?

Objective To evaluate if the administration of an immune enhancing enteral diet modulate metabolism inflammation,immune responses and outcome after surgery. Methods Eighty-eight patients with gastrointestinal cancer were randomly divided into two groups, one group was given an isocaloric and isonitrogenous standard diet and the other was given the supplemented diet with glutamine, arginine and ω 3 fatty acids. Feedings were started within 48 hours after operation, and continued one week. All variables were measured before operation and on postoperative day 1, 4 and 8. Blood was drawn at different time points to assess albumin, prealbumin and transferrin. Immune responses were determined by phagocytosis ability, respiratory burst of polymorphonuclear cells, total lymphocytes,lymphocyte subsets, nitric oxide, cytokines concentration, immunoglobins, and inflammatory responses by plasma levels of C-reactive protein(CRP),prostaglandin E 2 level.Mortality morbidity of infections complications and hospitalized time were also investigated.Results In supplemented group, the serum concentration of IgA, IgG, IgM, phagocytosis and respiratory burst after surgery was higher(P<0 01) than in the standard group. The supplemented group had higher levels of nitric oxide, total lymphocytes, T lymphocytes and T helper cells. Postoperative levels of IL 6 ?TNF α and CRP were lower in the supplemented group (P<0 05).There was no significant difference in albumin?everyday and accumulated nitric balance.On the 8th day after operation,serum concentrations of prealbumin and transferrin were higher in supplemented group.There was no significant difference in morbidity of infectious complications in postoperative 4 days.After the 4 days,the morbidity was signifcantly lower in supplemented group than standard group.The mean hospitalized time was also lower in supplemented group.Conclusion Supplementation of enteral immunonutrition positively can modulate postoperative stress and inflammatory responses and improve immune function and prognosis.