术后肠内外营养支持对食管癌患者免疫力与炎性反应的影响

Effect of postoperative enteral and parenteral nutrition on the immunity and inflammatory reaction of esophageal cancer patients

目的探讨在食管癌术后采用肠内外营养支持对患者免疫力与炎性反应的影响。方法将106例食管癌术后患者按照随机数字表法随机分为对照组与观察组,每组各53例,对照组给予单纯肠内营养支持,观察组给予肠内外营养支持措施,比较两组营养支持前和支持后营养、免疫和炎性指标变化情况。结果观察组术后7 d转铁蛋白(transferrin,TRF)与前白蛋白(prealbumin,PAB)水平均高于对照组,白介素-6(interleukin-6,IL-6)、C反应蛋白(C reactive protein,CRP)与肿瘤坏死因子α(tumor necrosis factorα,TNF-α)均低于对照组(均P<0.05)。观察组术后7 d、14 d与3个月的免疫球蛋白A(immunoglobulin A,IgA)、 IgM、 IgG、 CD_3^+、 CD_4^+与CD_4^+/CD_8^+均高于对照组(均P<0.05)。观察组术后恶心、腹泻、肺不张、睡眠障碍与低钾血症发生率均低于对照组(均P<0.05)。结论肠内外营养支持方式有利于改善食管癌手术患者的营养状态,提高机体免疫功能,并降低炎性反应。

Objective To discuss the effect of postoperative enteral and parenteral nutrition on the immunity and inflammatory reaction of esophageal cancer patients.Methods One-hundred-and-six patients after esophageal cancer surgery were randomly assigned into the control group and the observation group according to the random number table method,with 53 cases in each group.The control group received enteral nutrition only,and the observation group received both enteral and parenteral nutritional.The preoperative and postoperative nutritional status,immune function and inflammatory index were compared between the two groups.Results The levels of transferrin(TRF)and prealbumin(PAB)at 7 d after operation were significantly higher in the observation group than those in the control group,whereas the levels of interleukin-6(IL-6),C reactive protein(CRP)and tumor necrosis factorα(TNF-α)were all significantly lower in the observation group than those in the control group(all P<0.05).Moreover,at 7 d,14 d and 3 months after surgery,the levels of immunoglobulin A(IgA),IgM,IgG,CD3+,CD4+and CD4+/CD8+were all significantly higher in the observation group than those in the control group(all P<0.05).Finally,the incidences of nausea,diarrhea,atelectasis,sleep disturbance and hypokalemia were significantly lower in the observation group than those in the control group(all P<0.05).Conclusion The enteral and parenteral nutrition therapy is helpful to improve the nutritional status of patients after esophageal cancer surgery,and helpful in improving the immune function and reducing the inflammatory response.