营养支持治疗对肝癌患者术后应激指标、营养状况、远期生存率的影响

Effects of nutritional support therapy on postoperative stress index,nutritional status and long-term survival rate of liver cancer patients

目的观察营养支持治疗对肝癌患者术后应激指标、营养状况、远期生存的影响。方法选取2015年1月至2016年6月成都市公共卫生临床医疗中心收治的112例肝癌手术患者作为研究对象,按照随机数字表法分为对照组和治疗组各56例。对照组患者术后给予静脉营养输注治疗,观察组患者则给予早期肠内营养输注治疗,连续治疗7 d。观察两组患者的术后恢复情况,检测并比较患者术前、术后创伤应激指标、营养学指标,随访统计患者3年内的远期生存率,记录患者术后并发症的发生率。结果与对照组组间比较,观察组患者术后恢复更快,首次肛门排气时间、首次排便时间、早期进食时间均缩短(均P<0.05);术后两组患者的创伤应激指标皮质醇(Cor)、醛固酮(ALD)、去甲肾上腺素(Ne)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)均先升高,后随着时间的推移而逐渐降低,同一时间点组间比较,观察组患者的各应激指标均低于对照组(均P<0.05);术后观察组患者的营养状况优于对照组,营养学指标血红蛋白(Hb)、白蛋白(Alb)、转铁蛋白(TRF)、前白蛋白(PA)、红细胞(RBC)均高于对照组(均P<0.05);随访3年的生存率高于对照组(P<0.05);术后观察组患者并发症的发生率低于对照组(P<0.05)。结论早期肠内营养支持治疗更利于促进术后患者的机体恢复,在减轻术后患者的应激创伤、改善营养状况、提高远期生存率、降低术后并发症方面具有更好的效果。

Objective To explore the effects of nutritional support therapy on postoperative stress index,nutritional status and long-term survival of liver cancer patients.Methods One hundred and twelve patients with liver cancer admitted to Chengdu Public Health Clinical Medical Center from January 2015 to June 2016 were selected and divided into control group and treatment group equally by the method of random number table.Patients in the control group were treated with intravenous nutrition infusion after surgery,while patients in the observation group were treated with early enteral nutrition infusion for 7 days.The post-operative recovery of the two groups of patients was observed,and the indicators of pre-and post-operative traumatic stress and nutrition were compared.The long-term survival rate of the patients within 3 years was followed up with the incidence of post-operative complications being recorded.Results Compared with the patients in control group,the patients in observation group had faster post-operative recovery and earlier first anal exhaust,first defecation and feeding(P<0.05).The post-operative traumatic stress indexes of Cor,Ne,ALD,TNF-αand IL-6 in the two groups increased firstly,and then gradually decreased as time went on.Compared with the control group at the same time point,the changes of various stress indexes in the patients in observation group were significantly lower than those in the control group(P<0.05).The nutritional status of the observation group was better than that of the control group,and the nutritional indexes of Hb,Alb,TRF,PA and RBC were significantly higher than those of the control group(P<0.05).The survival rate after 3-year follow-up was significantly higher than that of the control group(P<0.05).The incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusions Early enteral nutrition support therapy is more conducive to promoting the postoperative recovery of patients,which has better effects in reducing the incidence of postoperative stress trauma and post-operative complications,improving nutritional status and long-term survival rate.