中药辅助肠外营养对胃癌患者术后机体营养状态的影响

Effect of parenteral nutrition assisted by traditional Chinese medicine on postoperative nutritional status in patients with gastric cancer

目的观察在胃癌患者根治术后肠外营养(PN)支持治疗中联合应用中药黄芪注射液对改善机体营养状态的影响。方法选取南阳医学高等专科学校第一附属医院2020年8月至2022年1月收治的84例胃癌患者进行随机对照试验。采用随机数字表法将患者分为观察组和对照组,各42例。观察组男22例,女20例,年龄(55.16±0.25)岁。对照组男23例,女19例,年龄(55.13±0.31)岁。两组术后均予以PN治疗,观察组在其基础上,采用黄芪注射液配合治疗。对比两组患者治疗7、15、30d后体质量指数(BMI)、预后营养指数(PNI),治疗前后白蛋白(ALB)、转铁蛋白(TFN)、纤维连接蛋白(FN)等营养指标,以及治疗后生活质量、不良反应发生情况。采用t检验和χ^(2)检验。结果治疗7、15、30d后,观察组BMI均高于对照组[(21.47±0.25)kg/m^(2)比(20.54±0.35)kg/m^(2)、(23.24±0.31)kg/m^(2)比(21.06±0.45)kg/m^(2)、(23.79±0.39)kg/m^(2)比(22.13±0.36)kg/m^(2),t=14.013、25.855、20.269,均P<0.001]。治疗7、15、30 d后,观察组PNI均低于对照组[(42.14±0.36)%比(45.33±0.27)%、(38.45±0.37)%比(41.44±0.25)%、(32.11±0.46)%比(36.42±0.37)%,t=45.941、43.394、47.315,均P<0.001]。治疗后,观察组ALB、TFN、FN均高于对照组[(45.11±0.87)g/L比(42.72±0.33)g/L、(3.75±0.77)g/L比(2.64±0.17)g/L、(3.36±0.32)g/L比(2.14±0.41)g/L,t=16.646、9.123、15.202,均P<0.001]。治疗后,观察组生活质量综合评定问卷(GQOLI-74)躯体功能、心理功能、社会功能、物质生活状态、总体生活质量因子评分均高于对照组[(86.24±0.31)分比(84.14±0.25)分、(86.65±0.44)分比(84.33±0.27)分、(87.68±0.48)分比(85.16±0.36)分、(85.36±0.41)分比(83.14±0.28)分、(15.33±0.24)分比(13.24±0.16)分,t=34.174、29.125、27.219、28.978、46.958,均P<0.001];观察组不良反应发生率略高于对照组[9.52%(4/42)比7.14%(3/42),χ^(2)=0.371,P=0.543]。结论在予以胃癌患者术后PN治疗的同时,加用黄芪注射液可显著改善机体营养状态,对提升患者生活质量具有积极意义,且加用此药未增加患者不良反应发生风险,安全性较高。

Objective To observe the effect of astragalus injection combined with parenteral nutrition(PN)on nutritional status in patients with gastric cancer after radical operation.Methods Eighty-four patients with gastric cancer admitted to The First Affiliated Hospital of Nanyang Medical College from August 2020 to January 2022 were selected for the random control trial.The patients were divided into an observation group and a control group by the random number table method,with 42 cases in each group.There were 22 males and 20 females in the observation group;they were(55.16±0.25)years old.There 23 males and 19 females in the control group;they were(55.13±0.31)years old.Both groups took PN after the surgery;in addition,the observation group took astragalus injection.The body mass indexes(BMI),prognosis nutritional indexes(PNI)7,15,and 30d after the treatment,the levels of albumin(ALB),transferrin(TFN),fibronectin(FN),and other nutritional indicators before and after the treatment,and the quality of life and adverse reactions after treatment were compared between the two groups.t and χ^(2) tests were applied.Results Seven,15,and 30d after the treatment,the BMI's in the observation group were higher than those in the control group[(21.47±0.25)kg/m^(2) vs.(20.54±0.35)kg/m^(2),(23.24±0.31)kg/m^(2) vs.(21.06±0.45)kg/m^(2),and(23.79±0.39)kg/m^(2) vs.(22.13±0.36)kg/m^(2);t=14.013,25.855,and 20.269;all P<0.001].Seven,15,and 30 d after the treatment,the PNI's in the observation group were lower than those in the control group[(42.14±0.36)%vs.(45.33±0.27)%,(38.45±0.37)%vs.(41.44±0.25)%,and(32.11±0.46)%vs.(36.42±0.37)%;t=45.941,43.394,and 47.315;all P<0.001].After the treatment,the levels of ALB,TFN,and FN in the observation group were higher than those in the control group[(45.11±0.87)g/L vs.(42.72±0.33)g/L,(3.75±0.77)g/L vs.(2.64±0.17)g/L,and(3.36±0.32)g/L vs.(2.14±0.41)g/L;t=16.646,9.123,and 15.202;all P<0.001].The scores of physical function,psychological function,social function,material life status,and overall quality of life factor of Generic Quality of Life Inventory-74(GQOLI-74)in the observation group were higher than those in the control group[(86.24±0.31)vs.(84.14±0.25),(86.65±0.44)vs.(84.33±0.27),(87.68±0.48)vs.(85.16±0.36),(85.36±0.41)vs.(83.14±0.28),and(15.33±0.24)vs.(13.24±0.16);t=34.174,29.125,27.219,28.978,and 46.958;all P<0.001].The incidence of adverse reactions in the observation group was slightly higher than that in the control group[9.52%(4/42)vs.7.14%(3/42);χ^(2)=0.371,P=0.543].Conclusion PN combined with astragalus injection for gastric cancer patients after surgery can significantly improve their nutritional status and quality of life and does not increase the risk of adverse reactions with high safety.