胃肠肿瘤__

胃肠道恶性肿瘤围手术期肠内免疫营养的应用研究

http://www.100md.com 《中国普通现代外科进展》 2005年第4期

胃肠肿瘤,,胃肠肿瘤·围手术期医护·肠道营养·免疫，细胞·免疫球蛋白类·并发症,1材料和方法,2结果,3讨论,参考文献

     【摘要】目的：评价肠内免疫营养对胃肠道恶性肿瘤患者术后免疫功能、炎症反应、营养状态、术后并发症的影响。方法：将60例胃肠道恶性肿瘤患者随机分为两组(每组30例)。两组患者围手术期(术前5d、术后7d)分别接受肠内免疫营养(免疫营养组)和等氮等热量的普通肠内营养(普通营养组)，于术前5d和术后1、4、8d分别检测各组患者免疫、炎症反应及营养指标，记录各组患者术后并发症、住院天数和肠功能恢复时间。结果：术后4、8d，免疫营养组多数免疫指标、前白蛋白明显高于普通营养组(P0.05)，炎症指标CRP明显低于普通营养组(P0.05)免疫营养组的术后总并发症发生率、感染性并发症发生率和住院天数明显低于普通营养组(P0.05)。结论：围手术期肠内免疫营养可在术后早期提高胃肠道恶性肿瘤病人的免疫功能，减轻手术创伤后的应激反应程度，提高胃肠道恶性肿瘤病人的内脏蛋白浓度，显著降低胃肠道恶性肿瘤病人的术后感染性并发症发生率和术后总并发症发生率，缩短住院时间。

    【关键词】胃肠肿瘤·围手术期医护·肠道营养·免疫，细胞·免疫球蛋白类·并发症

    Study of perioperative enteral immunonutrition in patients with gastrointestinal cancer

    YAO Hui,XU Liang,PANG Minghui,WAN Liyi,WANG Yuanzheng,LIU Yong

    Department of General Surgery,Affiliated Hospital of Luzhou Medical College (Sichuan 646000,China)

    【ABSTRACT】Objective:To evaluate the effects of perioperatively administrated enteral immunonutrition in gastrointestinal cancer patients on immune and inflammatory responses,nutrition states and postoperative morbidity.Methods:Sixty patients with gastrointestinal cancer were divided randomly into two groups.Two groups perioperatively(from preoperative day 5 to postoperative day 7) received an supplemented diet with arginine,RNA,and ω3fatty acids(immunonutrition group;n=30) or an isoenergetic and isonitrogenous standard diet (standardnutrition group;n=30).All variables of immune and inflammatory responses,nutrition states and postoperative morbidity were measured on preoperative day 5 and postoperative day 1,4 and 8.Results:On postoperative day 4 and 8,most immune variables and prealbumin in the immunogroup were significantly higher than those in the standardgroup(P0.05),and inflammatory variables as CRP in the immunonutrition group were significantly lower than those in the standard group.In the immunonutrition group,there were significantly fewer patients who experienced postoperative complications and shorter days of hospital stay compared with standard group(P0.05).Conclusion:The perioperative administration of enteral immunonutrition in gastrointestinal cancer patients can significantly modulate the postoperative immunosuppressive and inflammatory responses at the early postoperative day,can significantly decrease the occurrence of infectious and overall postoperative complications as well as the length of hospital stay. ......

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