术后早期肠内营养对食管癌患者肠黏膜屏障功能的影响

目的 探讨食管癌患者术后早期施行肠内营养支持对胃肠道黏膜屏障的保护作用. 方法术前3个月内体重下降超过患病前体重20%的食管癌患者56例,按所给营养方法不同分为肠内营养组(n=30)和肠外营养组(n=26),观察两组患者的临床结果,分别于术后第1、4和8天测定两组患者尿乳果糖与甘露醇的比值、血浆内毒素、肿瘤坏死因子(TNF)、胃泌素和谷氨酰胺水平. 结果肠内营养组患者术后体重减轻较少,感染性并发症发生较少(P<0.01,0.05).术后第4天和8天,肠内营养组尿乳果糖与甘露醇比值、血浆内毒素和TNF较肠外营养组低(P<0.01),胃泌素、谷氨酰胺较肠外营养组高(P<0.01). 结论食管癌患者术后早期肠内营养对肠道黏膜屏障功能具有一定的保护作用,有可能减少术后感染性并发症的发生.

The effect of early enteral nutrition on intestinal mucosa barrier in patients with esophageal carcinoma after operation

Objective To explore the protective effect of early enteral nutrition on intestinal mucosa barrier in patients with esophageal carcinoma after operation. Methods Fifty six patients with esophageal carcinoma whose weight decreased more than 20% before operation in three months were divided into enteral nutrition group ( n =30) and parenteral nutrition group ( n =26). Plasma concentration of lipopolysaccharide(LPS), tumor necrosis factor (TNF), gastrin, glutamine, and ratio of lactulose and mannitol (L/M) were measured on the 1st, 4th, 8th day after operation respectively. Results Weight loss and infectious complication in enteral nutrition group were less than those in parenteral nutrition group after operation ( P <0.01, 0.05). On the 4th and 8th day after operation,the level of LPS,TNF, and L/M were lower in enteral nutrition group than those in parenteral nutrition group ( P <0 01), the values of gastrin and glutamine were higher in enteral nutrition group than those in parenteral nutrition group ( P <0 01). Conclusion Enteral nutrition can protect the intestinal mucosa barrier and decrease infectious complication after operation.