术中输注红细胞对消化道肿瘤患者术后免疫功能的影响

目的探讨消化道肿瘤患者术中输入红细胞对术后免疫功能的影响。方法采用流式细胞仪分别对118例消化道肿瘤患者术前、术后一周外周血NK细胞及T细胞含量进行测定;其中42例患者行术中输入异体悬浮红细胞2⁴ U(A组),39例患者术中输入异体少白细胞红细胞24 U(A组),39例患者术中输入异体少白细胞红细胞2⁴ U(B组),37例未行术中输血(C组),对三组进行术前及术后外周血T细胞及NK细胞含量的比较。结果 A组和B组术后T细胞含量分别为(59.23±7.74)%和(62.12±6.43)%,明显低于C组(65.25±6.12)%(p<0.05);A组和B组与C组相比术后T细胞含量均有所降低,其中A组比B组降低更为明显(p<0.05)。A组术后NK细胞含量降低为(11.23±5.74)%,明显低于B组(15.12±4.43)%和C组(16.22±4.12)%,A组术后与其它组相比NK细胞含量下降差异均有统计学意义(p<0.05)。结论术中输入异体红细胞可导致消化道肿瘤患者术后免疫功能降低,临床上应减少术中红细胞输注,选择少白红细胞可以减轻对免疫功能的影响。     

基于消化道肿瘤患者术后常见并发症的护理分析

目的:分析消化道肿瘤患者术中并发症护理措施。方法:选取从2013年10月-2014年10月收治的68例消化道肿瘤患者,随机分为对照组(34)与护理组(34),对照组采取基础护理,护理组在对照组基础上采取综合护理,对比两组SAS评分、SDS评分以及并发症情况。结果:通过护理,护理组SAS与SDS评分明显优于对照组(P<0.05)。对照组并发症发生率为20.59%,护理组为2.94%,护理组明显低于对照组(P<0.05)。结论:对于消化道肿瘤患者,术后采取有效护理干预措施,能预防并发症,安全有效,具有临床应用价值。     

早期护理干预预防老年消化道肿瘤术后下肢深静脉血栓形成的积极作用探析

目的:探析早期护理干预预防老年消化道肿瘤术后下肢深静脉血栓形成的积极作用.方法:选择我院2014年2月~2017年2月收治的68例老年消化道肿瘤患者作为研究对象,根据随机数字法将68例患者均分成两组,取34例患者实施常规护理设作对照组,另外34例患者实施早期护理干预设作观察组,比较两组护理效果.结果:观察组发生下肢深静脉血栓率0%,与对照组11.76%相比,观察组发生下肢深静脉血栓率更低,护理效果更为理想,两组对比有显著差异(P<0.05).结论:老年消化道肿瘤术后给予早期护理干预可以预防下肢深静脉血栓形成,减少下肢深静脉血栓发生,护理效果显著,值得推广应用.     

结肠镜、腹腔镜联合在下消化道肿瘤治疗中的应用

目的:研究结肠镜、腹腔镜联合,在下消化道肿瘤治疗中的应用。方法:选择2014年8月-2016年8月,到医院就诊的下消化道肿瘤患者,共132例,随机分为对照组和观察组,每组患者66例。对照组单独采用腹腔镜治疗方法进行治疗,观察组患者采用结肠镜、腹腔镜联合治疗方法进行治疗。治疗后,对比两组患者各项手术之间及恢复情况。结果:观察组患者在术中出血量、留置管时间、平均住院时间等指标上,均显著由于对照组患者(P0.05)。结论:在下消化道肿瘤的治疗中,对结肠镜、腹腔镜进行联合使用,能够取得更为理想的治疗效果。     

CRUSADE评分在ACS患者PCI术后药物致消化道出血中的预测作用

目的探讨CRUSADE评分在急性冠状动脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后药物致消化道出血中的预测作用。方法选取2017年7月至2017年12月我院收治的150例PCI术后ACS患者作为对照组,予以常规护理及随访;选取2018年1月至2018年6月收治的143例PCI术后ACS患者作为观察组,在常规护理随访的同时采用CRUSADE评分进行出血风险评估。比较两组患者出院后12个月内消化道出血发生率。结果两组的新发消化道出血事件发生率均随用药时间的延长而升高。观察组的消化道出血发生率随CRUSADE风险增加而上升(P<0.05)。结论CRUSADE评分系统在预测PCI术后ACS患者消化道出血方面具有较好应用价值。     

结构脂肪乳对消化道肿瘤术后患者炎性细胞因子和免疫功能的影响

目的 探讨结构脂肪乳对消化道肿瘤术后患者炎性细胞因子和免疫功能的影响.方法 选取2010年7月至2012年2月收治消化道肿瘤术后患者80例,按分层抽样法随机分为结构脂肪乳组(观察组)和物理混合的中/长链脂肪乳组(对照组),每组40例,于术后1 ～6d接受等氮、等热量的肠外营养.对比观察两组患者术后一般情况,分别于术前,术后1、7d检测血清炎性细胞因子和免疫功能指标.结果 在进行6d的肠外营养以后,两组患者生命体征、血常规、肝肾功能、血脂等均在正常范围,观察组术后感染相关并发症发生率[12.5％(5/40)]较对照组[25.0％(10/40)]低,术后住院时间[(12.9±0.7 d)]较对照组[(13.1±0.9)d]短,但差异无统计学意义(P＞0.05).两组术后1d血清白细胞介素(IL)-1、IL-2、IL-6及肿瘤坏死因子(TNF)-α浓度均有不同程度下降,随后逐渐回升,观察组术后7d血清IL-2、IL-6和TNF-α浓度[(987±203)、(277±107)、(197±98) ng/L]明显低于对照组[(1347±195)、(752±187)、(342±106) ng/L](P＜ 0.05);两组术后1d外周血IgG、IgA、IgM、CD3+、CD4+、CD8+水平均有不同程度下降,随后逐渐回升,观察组术后7d外周血IgG、CD3+、CD4+水平[(14.2±1.8) g/L、0.746±0.111、0.580±0.067]较对照组[(12.1±2.8) g/L、0.606±0.101、0.404±0.072]明显升高(P＜0.05).结论 结构脂肪乳能减轻消化道肿瘤术后患者免疫抑制,减轻炎性反应,调控炎性细胞因子的产生和释放,改善机体免疫功能.     

PET-CT在消化道肿瘤术后CEA、CA199升高患者中的应用价值

目的：研究与PET-CT在消化道肿瘤术后血清肿瘤标记物CEA、糖类抗原CA199升高患者中的临床价值。方法：回顾性分析24例消化道肿瘤术后患者血清CEA、CA199升高的临床资料,通过PET-CT检查,与病理及临床随访结果进行比较。结果：24例消化道肿瘤术后血清CEA、CA199升高患者中,PET-CT阳性19例。结论：血清肿瘤标记物CEA、糖类抗原CA199与PET-CT的联合应用对于消化道肿瘤术后的监测准确、可靠,对于继续治疗或二次治疗方案的选择具有重要的指导意义。     

内镜黏膜下剥离术（ESD）治疗消化道肿瘤的疗效和安全性评估

目的:分析内镜黏膜下剥离术(ESD)治疗消化道肿瘤的疗效和安全性。方法:选定本院收治的消化道肿瘤患者74例,研究时段自2017年1月~2019年1月,按照治疗方式分组,分对照组(37例,内镜黏膜切除术治疗)、观察组(37例,内镜黏膜下剥离术治疗),回顾分析患者临床资料,比较治疗及并发症情况。结果:观察组整块切除率、横向切缘阴性率、纵向切缘阴性率、治愈率分别为91.43%、91.89%、89.19%、81.08%,与对照组54.08%、70.27%、64.86%、51.35%相比较高,P<0.05;观察组并发症率(5.40%)与对照组(8.10%)相比存在差异,但无统计学意义,P>0.05。结论:在消化道肿瘤治疗中,内镜黏膜下剥离术与切除术相比更利于患者恢复,治疗效果理想,且不会增加并发症发生率,安全性较高。     

胸、腹腔镜联合食管癌手术消化道不同重建径路术后疗效分析

目的探析胸、腹腔镜联合食管癌手术采用不同重建消化道径路治疗的临床效果。方法选取我院行胸、腹腔镜联合食管癌手术患者160例,根据消化道重建径路的不同分为两组。80例患者采用食管床径路重建消化道作为食管床组,另80例患者采用胸骨后径路重建消化道作为胸骨后组,观察两组患者治疗后的疗效情况。结果两组患者手术时间、淋巴结清扫数量、术中出血量、住院时间比较无显著差异(P>0.05);两组术后胸腔引流量和胃肠减压液比较有显著差异(P<0.01)。两组术后两周肺部感染、吻合口漏、心房纤颤及其他方面等并发症发生情况比较无显著差异(P>0.05)。结论胸、腹腔镜联合食管癌手术采用食管床径路和胸骨后径路重建消化道,两种方式效果差异不大,应根据患者的病情,综合考虑个体因素后选择适宜的径路。     

消化道肿瘤患者外周血中CD4~+CD25~+调节性T细胞检测的临床意义

[目的]探讨消化道肿瘤患者外周血中CD4+CD25+调节性T细胞(Treg)的表达情况及其与消化道肿瘤发生、发展的关系。[方法]采用流式细胞术检测56例健康成人及56例消化道肿瘤患者外周血CD4+CD25+Treg的水平,分析和比较两组之间的差异及各指标之间的相关性,并进行统计学分析。[结果]健康成人对照外周血CD4+CD25+Treg比例为(9.35±2.88)%,消化道肿瘤患者比例显著增高为(17.85±3.85)%,两者比较有统计学意义(P﹤0.01)。消化道肿瘤患者外周血CD4+CD25+Treg比例与淋巴结转移和TNM分期有相关性,淋巴结转移阳性和TNM分期越晚,Treg比例越高。[结论]消化道肿瘤患者外周血CD4+CD25+Treg比率升高,导致免疫抑制功能增强,可能是消化道肿瘤发生的重要机制;且增高程度与肿瘤临床分期正相关,未来可作为消化道患者病情进展的重要预测指标。     

丙氨酰胺谷氨酰胺对烫伤大鼠的作用

目的研究添加丙氨酰谷氨酰胺(Ala-Gln)全胃肠外营养对烫伤大鼠的蛋白质代谢、肠粘膜形态学、创面肉芽组织的影响。方法将22只30%TBSAⅢ度烫伤SD大鼠行颈外静脉插管后,随机分为传统TPN组(传统组)和添加二肽TPN组(二伏组),每组各11例,两组接受等热量(780kg     

The effect of glutamine-supplemented total parenteral nutrition on nitrogen economy depends on severity of diseases in surgical patients

BACKGROUND: Gln is an important substrate for enterocyte and rapid proliferation cells. Studies have shown that parenteral supplementation of Gln maintains the intracellular Gln pool, improves nitrogen balance and shortens hospital stay. However, some studies showed Gln-supplemented TPN had no effect on restoring the Gln pool in critically ill patients. OBJECTIVE: To evaluate the effect of glutamine (Gln) dipeptide supplementation of total parenteral nutrition (TPN) on postoperative nitrogen balance and immune response of patients undergoing surgery. METHODS: This study is a prospective, randomized double-blind clinical trial. APACHE II score and TISS were used to evaluate the patients after admission. Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous (0.228 g nitrogen/kg/day) and isoenergetic (30 kcal/kg/day) TPN for 6 days. Two groups (Conv and Ala-Gln) were further divided to high (APACHE>or=6) and low (APACHE <6) groups. Control group (Conv) received 1.5 g amino acids/kg/day, whereas the Ala-Gln group received 0.972 g amino acids/kg/day and 0.417 g of L-alanyl-L-glutamine (Ala-Gln)/kg/day. Blood samples were collected on day 1 and day 6 after surgery for plasma amino acid and CD4, CD8 cell and T lymphocyte analysis. Cumulative nitrogen balance were also measured on day 2, 3, 4, 5 postoperatively. RESULTS: Although there was a tendency to have better cumulative nitrogen balance on the postoperative days in the Ala-Gln group, no significant difference was observed between two groups. However, a better significant cumulative nitrogen balance was observed on the 2nd, 3rd and 5th postoperative day in the Ala-Gln group than in the Conv group in patients with APACHE II <6, whereas no significant difference was noted in patients with APACHE II >or= 6. No difference in urine 3-methylhistidine excretion were observed between the 2 groups. Patients in the Ala-Gln group had significant higher T lymphocyte and CD4 cells than did those in the Conv group.CONCLUSION: TPN supplemented with Gln dipeptide had beneficial effect on enhancing the immune response. However, the effect of Ala-Gln administration on improving nitrogen economy was only observed in patients with low APACHE II scores. These results may indicate that Gln required for reversing the catabolic condition may depend on the characteristics and severity of the diseases.     

Clinical relevance of L-carnitine-supplemented total parenteral nutrition in postoperative trauma. Metabolic effects of continuous or acute carnitine administration with special reference to fat oxidation and nitrogen utilization

Carnitine-free total parenteral nutrition (TPN) is claimed to result in a carnitine deficiency with subsequent impairment of fat oxidation. The present study was designed to evaluate the possible benefit of carnitine supplementation on postoperative fat and nitrogen utilization. Sixteen patients undergoing total esophagectomy were evenly randomized and received TPN without or with L-carnitine supplementation (74 mumol.kg-1.d-1) during 11 postoperative days. On day 11, a 4-h infusion of L-carnitine (125 mumol/kg) was performed in both groups. The effect of supplementation was evaluated by indirect calorimetry, N balance, and repeated measurements of plasma lipids and ketone bodies. Irrespective of continuous or acute supplementation, respiratory quotient and fat oxidation were similarly maintained throughout the study in both groups whereas N balance appeared to be more favorable without carnitine. We conclude that carnitine-supplemented TPN does not improve fat oxidation or promote N utilization in the postoperative phase.     

谷氨酰胺强化的全肠外营养在大肠肿瘤患者术后的应用研究

目的探讨谷氨酰胺(Gln)强化的全肠外营养(TPN)对大肠肿瘤患者术后的作用。方法将40例大肠癌患者随机分为Gln-TPN组和常规TPN组。检测体重、肝肾功能、氮平衡(NB)、血浆白蛋白水平(Alb)、术后疲劳评分等各项指标的变化。结果两组病人术后体重、肝肾功能比较无统计学意义。术后Gln-TPN组白蛋白水平高于常规TPN组(P<0.01);氮平衡明显改善,与常规TPN组相比差异显著(P<0.01);主观感觉好于常规TPN组(P<0.05)。结论Gln-TPN组比常规TPN组有利于术后负氮平衡的改善及血浆白蛋白的恢复,减少术后并发症,并能显著改善术后疲劳。     

重组人生长激素对消化道术后病人氮平衡作用的研究

目的了解重组人生长激素(rhGH)对手术后病人氮平衡的影响。方法在肠全外营养(TIN)的基础上，加用rhGH治疗消化道大中型手术后10例病人，并与同期仅用TPN治疗的10例病人做对照研究。结果1．2组病人均未获得正氮平衡，但GH组氮平衡明显改善；术后5天累积氮平衡GH组显高于对照组。2．术后3天、5天，累积尿氮的排出，对照组较GH组高，二差别有显统计学意义。3．术后1天引流氮的排出、术后3天累积引流氮的排出及平均每天引流氮的排出，GH组均较对照组低，但无显的统计学意义。结论在低氮和低热的基础上，rhGH能减轻术后病人的负氮平衡。主要是通过减少尿氮的排出而达到节氮效果，rhGH对引流氮影响不大。     

谷氨酰胺对肿瘤病人术后营养状况及免疫功能的影响

目的 探讨谷氨酰胺对肿瘤病人术后营养状况及免疫功能的影响。方法 20例胃肠道肿瘤病人术后随机分为常规TPN组（对照组）10例和TPN＋Gln组（研究组）10例，治疗8天，观察血清前白蛋白、血清转铁蛋白、氮平衡变化。并检查其前后外周血IgG、IgM、IgA、C3、C4的变化。结果 （1）两组病人负氮平衡改善，研究组与对照组比较差异明显（P＜0．01）。两组病人血清蛋白均上升，研究组回升更明显，与对照组比较具有显差异（P＜0．01）。（2）研究组外周血IgG、IgM、IgA明显升高，与对照组比较差异显（P＜0．05）。研究组C3、C4明显升高与对照组比较差异显（P＜0．05）。结论 谷氨酰胺改善了肿瘤术后病人的营养状况，提高了免疫功能。     

Nutritional and hormonal effects of biosynthetic human growth hormone in surgical patients on total parenteral nutrition.

The anabolic effects of biosynthetic human growth hormone (BHGH) were tested on 30 patients, aged 37-68 yr, divided into four groups: group 1 received surgery plus total parenteral nutrition (TPN) plus BHGH, group 2 received just surgery and TPN, Group 3 received TPN and BHGH, and group 4 received just TPN. TPN was given as an all-in-one formula (glucose 4.7 g.kg.-1day-1, amino acids 1.2 g.kg-1.day-1, lipids 0.7 g.kg-1.day-1, electrolytes and trace elements. BHGH (0.25 IU.kg-1.day-1) or placebo were administered subcutaneously at 0800 for 10 days. Nitrogen and phosphorous balance, as well as the common plasma nutritional markers (transferrin, albumin, prealbumin), triglycerides, apolipoprotein B, insulin, and cortisol were evaluated daily. Urinary creatinine loss was evaluated on days 3, 7, and 10. Cumulative nitrogen balance was better in group 1 (-16.1 +/- 3.2 g N2) than in group 2 (-33.7 +/- 4.6 g N2) (P less than 0.01), whereas the difference was nonsignificant in groups 3 and 4. Phosphorous balance and creatinine excretion paralleled nitrogen balance. Plasma markers were not significantly improved in group 1 compared with group 2; however, they were significantly better in group 3 than in group 4. Lipids were better metabolized in the BHGH-treated groups. Insulin was increased in both groups 1 and 3, whereas cortisol did not rise after surgical stress, probably because of BHGH administration. A positive effect of BHGH on nutritional status and hormonal background is suggested by these data.     

Influence of stress, depletion, and/or malignant disease on the responsiveness of surgical patients to total parenteral nutrition

We performed a series of 14C[urea] infusions to assess the effect of depletion (greater than 15% decrease in body weight), stress (VO2 greater than 130 mumol.kg-1.min-1), and cancer on the basal rate of net protein catabolism (NPC) and the response of patients to total parenteral nutrition (TPN). Depleted patients had low rates of NPC (0.8 +/- 0.1 g.kg-1.d-1) compared with nondepleted patients (p less than 0.05) and during TPN anabolism was achieved (0.5 +/- 0.2 g.kg-1.d-1). Gastrointestinal (GI) cancer patients had rates of NPC similar to those of normal volunteers; during TPN, NPC approximated zero. Severely stressed (SS) nondepleted patients had high rates of NPC (2.7 +/- 0.2 g.k-1.d-1) whereas SS-depleted patients had lower (p less than 0.05) rates of NPC (1.9 +/- 0.3 g.kg-1.d-1); both groups of SS patients remained catabolic despite TPN (1.2 +/- 0.3 and 0.5 +/- 0.2 g.kg-1.d-1, respectively). In response to TPN, depleted patients become anabolic, GI cancer patients stop losing protein but do not become anabolic, and stressed patients remain catabolic and continue to loss protein.     

精氨酸增强的胃肠外营养在结直肠癌病人中的应用及临床意义

目的 :探讨精氨酸 (Arg)增强的胃肠外营养 (PN)对结、直肠癌病人术后的免疫功能、蛋白质代谢的影响。方法 :随机选择 4 0例结、直肠癌病人 ,术后分别接受常规PN支持或Arg增强的PN支持 1周 ,观察术前、术后不同时期的免疫功能、氮平衡、并发症及其他指标。　结果 :两组病人入院时均有明显的免疫抑制。TPN Arg组病人的免疫功能 (CD4 、CD4 /CD8 、NK、IL 2R)在术后第 4、7天与TPN组相比有明显改善 (P <0 .0 5 ) ;TPN Arg组病人在术后第 4天已达到氮平衡 ,与TPN组相比亦有明显差异 (P <0 .0 5 ) ;TPN Arg组病人术后未出现并发症 ,TPN组 2例病人出现切口并发症。　结论 :精氨酸能改善大肠癌病人术后的免疫功能、蛋白质代谢 ,降低术后并发症的发生率 ,能增强PN的效果     

肠内或肠外营养对手术后病人的氮平衡、 肠通透性、血浆氨基酸及费用等的影响

目的观察肠内营养、肠外营养对手术后病人的的氮平衡、肠通透性、费用等影响。对象 和方法随机、对照、多中心临床研究。60例合乎计划要求的食道、胃、结肠道手术的患者为对象。按随机表进入研究组或对照组，两组为等氮等热卡营养摄入。研究计划经伦理委员会批准。所有病人均知情同意参加。结果(1)安全性两组均无严重不良事件，对照组有2例肝功损害，研究组无肝功损害（P=0.19）。(2)替代(Surrogateefficacy)有效性指标(Endpointmarkers)(1)氮平衡研究组累积氮平衡为(108±107)mg