经皮内镜下胃/空肠造口术及瑞能在老年消化道肿瘤患者压力性损伤预防中的作用

Effect of percutaneous endoscopic gastrostomy or jejunostomy and Supportan in prevention of stress injury in elderly patients with digestive tract tumors

目的探讨经皮内镜下胃/空肠造口术(PEG/J)及瑞能在预防有营养风险老年消化道肿瘤患者压力性损伤中的作用。方法选取年龄≥60岁,禁食及卧床时间≥5 d,经Waterlow压疮危险评估表和营养风险筛查(NRS2002)评估为压力性损伤且有营养风险的104例老年患者,按回顾性队列研究设计,分为对照组、免疫营养组及普通营养组。比较3组患者压力性损伤发生率、血红蛋白(Hb)、血清白蛋白(ALB)、血清前白蛋白(PA)、体质量指数(BMI)、C反应蛋白(CRP)、白细胞介素-2(IL-2)、总淋巴细胞计数(TLC)、自然杀伤细胞(NK细胞)、CD3^+、CD4^+、CD8^+及CD4^+/CD8^+。结果治疗20 d后,免疫营养组患者的压力性损伤发生率、Hb、ALB、PA、BMI、CRP、IL-2、TLC、NK、CD3^+、CD4^+及CD4^+/CD8^+与对照组相比,差异均有统计学意义(P<0.05或P<0.01),普通营养组只有ALB、PA、BMI、CRP、CD4^+及CD4^+/CD8^+与对照组相比有显著差异(P<0.05或P<0.01)。结论对于有营养风险的老年压力性损伤高危消化道肿瘤患者,临床采用PEG/J加瑞能进行肠内营养,能有效改善营养状况,减轻炎症反应,提高免疫功能,降低压力性损伤的发生率。

Objective To study effect of percutaneous endoscopic gastrostomy or jejunostomy(PEG/J)and Supportan in prevention of stress injury in elderly patients with digestive tract tumors.Methods A total of 104 elderly patients aged 60 years or older,with time of fasting or bedridden≥5 days,assessed as stress injury risk and malnutriton by Waterlow and Nutritional Risk Screening(NRS2002)were selected.According to a retrospective cohort study,the patients were divided into control group,immune nutrition group and normal nutrition group.The incidences of stress injury,hemoglobin(Hb),serum albumin(ALB),prealbumin(PA),body mass index(BMI),C reactive protein(CRP),interleukin-2(IL-2),total lymphocyte count(TLC),nature killer(NK)cells,the ratios of CD3^+,CD4^+,CD8^+and CD4^+/CD8^+were compared.Results After 20 d of treatment,there were significnat differences in incidences of stress injury,Hb,ALB,PA,BMI,CRP,IL-2,TLC,NK cells,CD3^+,CD4^+,and CD4^+/CD8^+between the control group and immune nutrition group(P<0.05 or P<0.01).However,ALB,PA,BMI,CRP,CD4^+and CD4^+/CD8^+were statistically significant in normal nutrition group(P<0.05 or P<0.01).Conclusion After being given Supportan through PEG/J to elderly digestive tract tumors patients with risks of stress injury and malnutriton,the nutritional status and immune function will be improved,inflammation reactions and incidences of stress injury will be reduced.