全胃切除术后肠内营养支持

Support effects of enteral nutrition after total gastrectomy

目的对比全胃切除术后肠内营养(EN)与标准肠外营养(PN)支持的效果。方法30例患者随机分为EN和PN组,两组患者从术后1d到术后10d进行等氮、等热量的营养支持。术前和术后11d测量体重,检测血中白蛋白、免疫球蛋白(Ig)A、IgG、IgM、淋巴细胞计数、T淋巴细胞亚群分类和血中谷氨酰胺含量及计算累积氮平衡。结果术后11d与术前比较,PN组的体重、白蛋白下降较EN组明显(P<0.05);血中谷氨酰胺下降也明显,与术前及与EN组相比,差异有非常显著性意义(P<0.01)。PN组累积氮平衡为(114.6±19.5)mg·kg-1·(11d)-1,而EN组为(203.6±31.8)mg·kg-1·(11d)-1,EN组明显优于PN组。体液免疫指标和T淋巴细胞亚群,EN组术后11d基本恢复到术前水平,而PN组与术前相比,尚有差异。结论全胃切除术后EN支持比标准PN支持有更好的代谢效果,能更好地恢复患者术后的免疫功能。

Objective To compare the support effects between enteral nutrition(EN) and parenteral nutrition(PN) in patients after total gastrectomy. Methods Thirty patients after total gastrectomy were randomly divided into EN and PN group, and received iso nitrogenous, iso caloric nutritional support from the first day to the 10th day after operation. Serum albumin,immunoglobulin,peripheral blood T lymphocyte subsets and serum glutamine were measured before operation and on the 11th day after operation. Results Compared with the preoperative results, weight loss and decrease of serum albumin and glutamine were more evident in PN group than those in EN group. The cumulative nitrogen balance was (114 6±19 5) mg·kg-1·(11 d)-1 in PN group and (203 6±31 8)mg·kg-1·(11 d)-1 in EN group(P< 0 01). The indexes of immune function were improved significantly in EN group. Conclusion EN is more efficient in metabolic effect, and superior to PN to improve immune function in patients after total gastrectomy.