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目的：比较肠外营养与肠内营养对胃癌病人术后细胞免疫功能的影响。方法：45例胃癌病人随机分为2组，其中肠外营养（PN）组23例，肠内营养9EN）组22例。术后第1天开始行肠外或肠内营养支持，时间1周，检测术前和术后第8天外周血T淋巴细胞亚群（CD3^ 、CD4^ 、CD8^ ）和NK细胞活性等细胞免疫指标。结果：PN组术后CD3^ 、CD4^ 水平和NK细胞活性明显下降，CD8^ 水平明显升高；而EN组术后CD3^ 、CD4^ 、CD8^ 水平和NK细胞活性与术前相比无显著性变化。结论：肠外营养对胃癌病人术后细胞免疫功能无明显改善作用，而肠内营养有明显的细胞免疫增强作用，可有效地纠正胃癌病人术后细胞免疫抑制状态。     

营养不良的胃肠道肿瘤患者术后营养支持的随机对照研究

目的评价术后营养支持对营养不良的胃肠道肿瘤患者预后的影响。方法646例营养不良的胃肠道肿瘤患者随机分为肠外营养组(215例)和肠内营养组(215例)及对照组(216例),术后营养支持7d,采用等热卡[125.5kJ(30kcal)·kg-1·d-1]和等氮(0.25g·kg-1·d-1);对照组术后常规补液直至恢复正常饮食。观察比较术后死亡率、并发症发生率及住院时间。结果入选的3组患者资料具有可比性。术后总死亡率为1.5%,3组间差异无统计学意义。术后并发症发生率:肠外营养组33.5%(72例),肠内营养组28.4%(61例),对照组44.9%(97例);对照组与肠外营养组比较,P=0.001;与肠内营养组比较,P=0.000。肠内营养组感染性并发症发生率10.2%,明显低于肠外营养组的15.3%,P=0.002;而两组非感染性并发症发生率差异无统计学意义(21.9%vs.23.7%,P=0.06)。住院时间:肠外营养组(11.2±5.0)d,肠内营养组(9.8±3.4)d,对照组(14.5±7.1)d;肠内营养组住院时间短于肠外营养组,P=0.002;对照组与肠外营养组比较,P=0.003;与肠内营养组比较,P=0.001。结论术后营养支持可改善营养不良的胃肠道肿瘤患者的预后,术后早期肠内营养较肠外营养能降低术后感染性并发症发生率,并缩短住院时间。     

外伤性肠破裂修补术后早期肠内营养对改善患者营养状况的作用观察

目的：观察外伤性肠破裂修补术后早期肠内营养对改善患者营养状况的作用。 方法：选取2010年1月—2012年12月收治的34例外伤性肠破裂手术患者,将其随机分为观察组 （17例）和对照组（17例）。对照组术后采取全肠外营养支持,观察组于术后24 h开始给予早期肠内营养,共维持1周。并于术前、术后7d观察两组患者营养相关指标。 结果：治疗组术后肠道功能恢复时间和住院时间较对照组明显缩短,组间差异有统计学意义（P<0.05）。 结论：与肠外营养相比,肠破裂修补术后早期肠内营养在促进肠蠕动恢复、缩短患者住院时间方面的效果优于肠外营养。     

早期肠内营养在胃癌术后应用的疗效观察

目的：观察胃癌术后患者早期肠内营养支持的近期疗效。 方法：将117例患者随机分为肠内营养组与肠外营养组,于术后24h开始分别给予肠内与肠外营养,比较两组患者术后营养状况、免疫水平和临床恢复情况的差异。 结果：在供能基本相同的情况下,肠内营养组在术后短期内免疫水平和临床恢复及住院时间方面都优于肠外营养组（均P<0.05）。 结论：术后早期肠内营养能够有效改善胃癌术后患者的免疫功能,加快胃肠道功能的恢复。     

梗阻性黄疸病人术后早期肠内营养的临床研究

目的探讨梗阻性黄疸病人术后早期肠内营养疗效及安全性。方法梗阻性黄疸病人60例,随机分成肠内营养组（30例）及肠外营养组（30例）。术前及术后第1、4,7天监测谷丙转氨酶、谷草转氨酶、胆红素及营养代谢指标。记录并发症、术后肠道恢复通气时间和营养治疗费用。结果两组谷丙转氨酶、谷草转氨酶变化差异无显著性（P〉0．05）;肠内营养组胆红素下降速度较肠外营养组快;胃肠道功能恢复时间肠内营养组明显早于肠外营养组（P〈0．01）;两组住院时间差异无显著性（P〉O．05）;肠内营养组治疗费用约为肠外营养组的1／4。结论梗阻性黄疸病人术后早期肠内营养是安全而有效的,可有效改善病人的营养状况;减少并发症的发生;可加快降低高胆红素血症者的胆红素水平。具有促进胃肠道功能恢复和降低治疗费用的优势。     

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目的 和肠外营养相比,观察肠内营养能否降低外科手术病人血液内毒素水平。方法 ４１例接受外科大手术病人随机分成肠内营养组２１例,肠外营养组２０例。在术后第１日开始行肠内营养或肠外营养支持。术前、术后第３ｄ和第８ｄ抽血查白蛋白、纤维连续蛋白、转铁蛋白、γ－ＧＴ、ＡＬＴ、胆红素以及内毒素。结果 术后第３ｄ和术后第８ｄ,两组蛋白指标差异无显著性意义（Ｐ〉０．０５）。术后,肠外营养组γ－ＧＴ水平持续升高,而     

经皮空肠营养置管肠内营养应用于全胃切除术胃癌患者的临床研究

目的 探讨术中经皮空肠营养置管早期肠内营养对全胃切除胃癌患者的营养状态及免疫功能的影响.方法 将113例胃癌患者随机分成两组,术中空肠营养管置入肠内营养组(66例)和肠外营养支持组(47例).两组均行全胃切除术,术后分别接受7d同等条件的营养支持,比较两组排气时间、并发症发生率,检测两组患者术前和术后3、7d有关的实验室指标.结果 肠内营养组的肛门排气时间明显短于肠外营养组[(4.1±2.2)d比(5.1±2.0)d,t=2.156,P=0.037];肠内营养组与肠外营养组相比,术后7d血清前白蛋白显著增高[(18±7)mg/dl比(14±7) mg/dl,t=2.370,P=0.022]、转铁蛋白水平明显增高[(205±45)mg/dl比(186±39) mg/dl,t=3.665,P=0.001];术后7d肠内营养组与肠外营养组相比,血清IgA[(2.3±1.0) g/L比(1.9±0.7) g/L,t=2.178,P=0.034]、IgM[(1.4±0.4) g/L比(1.0±0.4) g/L,t =2.124,P=0.039]、IgG[(9.5±1.9) g/L比(9.0±2.3) g/L,t =2.189,p=0.033]均显著增高;术后肠内营养组消化道功能障碍发生率低于肠外组(3％比13％,x2=3.962,P=0.048).结论 胃癌全胃切除术患者术中经皮穿刺空肠营养管置入予以术后早期肠内营养安全方便,营养状态及免疫水平改善均优于肠外营养.     

胃癌根治术后早期肠内营养支持的效果观察

目的探讨早期肠内营养支持对胃癌根治术后患者恢复的影响。方法将22例胃癌术后患者随机分为肠内营养组与肠外营养组,于术后20h内开始分别给予肠内与肠外营养,比较两组患者术后肛门首次排气时间、住院时间及并发症情况。结果与肠外营养组比较,肠内营养组患者术后肛门首次排气时间短、住院时间短,两组均无严重并发症发生。结论早期肠内营养可加快胃癌根治术后患者胃肠功能的恢复,是一种安全可行的营养支持方式。     

ω-3多不饱和脂肪酸联合营养支持治疗在肝切除术后应用的临床研究

目的 通过比较不同营养支持方案的作用,评价ω-3多不饱和脂肪酸联合营养支持治疗在肝切除术后应用的临床效果。方法 采用回顾性对照研究的方法.选择2009年1月-2011年1月南京大学医学院附属鼓楼医院82例行肝切除术患者,依照围手术期不同的营养支持方案分为全肠外营养组（23例,简称肠外组）、联合肠内营养组（30例,简称肠内组）和ω-3不饱和脂肪酸组（29例,简称ω-3 PUFAs组）。肠外组术后给予全肠外营养支持;肠内组在静脉营养支持基础上术后早期口服肠内营养;ω-3 PUFAs组在肠内组基础上,术后加用ω-3多不饱和脂肪酸。通过比较3组患者术后恢复情况、并发症发病率、肝功能等临床指标综合评估不同营养支持方案的疗效。结果 （1）3组患者术后均无胆漏、胆道出血等严重并发症,轻微并发症包括腹腔积液、胸腔积液,3组间差异无统计学意义;（2）与肠外组比较,肠内组、ω-3 PUFAs组术后排便时间、术后住院天数较短,差异有统计学意义（P =0.001,=4.624;P =0.001,t =5.019）;肠内组、ω-3PUFAs组间差异无统计学意义（P＞0.05）;（3）对于大范围（≥4个肝段）肝切除患者,与肠内组相比,ω-3PUFAs组术后第3、5天ALT值较低,差异有统计学意义（P=0.024,t=2.432;P=0.042,=2.144）;（4）对于有肝硬化的患者,与肠内组相比,ω-3 PUFAs组术后第3、5天胆红素值较低,差异有统计学意义（P=0.032,t=2.202;P=0.035,t =2.183）。结论 肝切除术后早期给予肠内营养并联合肠外营养支持,可加速患者康复;对于有肝硬化背景及大范围肝切除的患者,ω-3 PUFAs联合营养支持治疗对肝功能的保护作用尤为明显。     

肠内和肠外营养对胃肠道肿瘤患者术后恢复及免疫功能的影响

目的探讨早期肠内营养和全肠外营养对胃肠道肿瘤根治术后患者恢复效果及对免疫指标IgG、IgM、IgA水平的影响。方法选取2013年6月至2015年6月间80例胃肠道肿瘤患者作为研究对象,根据入院单双号随机分为肠内营养组(采用早期肠内营养支持)和肠外营养组(采用全肠外营养支持)。采用统计学软件SPSS 19.0对数据进行处理,两组不良反应发生人数等采取率(%)表示,组间率采取χ2检验;术前、术后血清相关指标免疫指标以及住院时间、住院费用等采取(x±s)表示,计量资料先作正态性检验,服从正态使用单样本t检验;不服从正态,使用配对秩和检验采用t检验;P0.05为差异统计学意义。结果两组患者术前各项指标没有差异(P0.05),术后第1天,两组患者的血清白蛋白(ALB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)等指标明显高于术前(P0.05),血清前白蛋白(PA)、血清总蛋白(TP)明显低于术前(P0.05),血红蛋白(HB)变化不显著。术后第8天,肠内营养组各项指标均恢复正常,而肠外营养组仅有ALB、PA、TP恢复正常,肠内营养组患者血清相关指标水平明显优于对照组(P0.05);肠内营养组患者发生呕吐、腹泻、腹痛和腹胀的人数均少于肠外营养组患者,总发生率5.0%(2/40)显著低于肠外营养组的30.0%(12/40),差异具有统计学意义(χ~2=6.617,P0.05)。结论早期肠内营养能够更有效的改善患者血清相关指标和免疫力,促进快速恢复,安全高效,值得推广运用。     

老年胃癌术后早期营养支持方式临床研究

目的探讨老年胃癌术后合理的早期营养支持方式。方法前瞻性入组2010年1月至2013年3月间厦门大学附属第一医院收治的120例老年胃癌术后患者,按随机数字表法分为完全肠外营养组（TPN）、完全肠内营养组（TEN）及部分肠内加肠外营养组（EN加PN）,每组40例。比较3组患者营养支持治疗耐受性、术后7d营养指标和免疫指标、术后肛门排气时间及感染并发症发生率。结果在营养支持过程中,EN加PN组耐受性（97．5％,39／40）明显高于TPN组（82．5％,33／40）和TEN组（80．0％,32／40）（P〈0．05）。术后7d,3组患者体质量指数、血浆白蛋白、前白蛋白及转铁蛋白水平等营养指标的差异均无统计学意义（P〉0．05）;但EN加PN组和TEN组CD3、CD4、CD4／CD8等免疫指标明显高于TPN组（均P〈0．05）。EN加PN组和TEN组感染发生率明显低于TPN组[5．13％（2／39）和6．25％（2／32）比12．12％（4／33）,P〈0．05],肛门排气时间明显快于TPN组f（49．5±22．1）h和（48．2±17．6）h比（68．2±16．7）h,P〈0．05]。结论老年胃癌术后早期行肠内营养安全可行．EN加PN为最佳的早期营养支持方式。     

Total enteral nutrition versus total parenteral nutrition after major torso injury: attenuation of hepatic protein reprioritization

Reprioritization of hepatic protein synthesis, a process involving accelerated production of acute-phase proteins at the expense of constitutive proteins, accompanies major trauma. The impact of isocaloric, isonitrogenous total enteral nutrition (TEN) versus total parenteral nutrition (TPN) on hepatic reprioritization was investigated in a prospective, randomized trial. Of the 59 patients with an abdominal trauma index (ATI) greater than 15 but not more than 40, 45 evaluable patients were followed. Results from 36 (18 TEN, 18 TPN) evaluable patients revealed that mean serum levels of acute-phase proteins increased, whereas mean serum levels increased to a greater extent in the TPN group. The maximal increase from baseline for the acute-phase response in both groups occurred at postinjury day 5 and was significantly higher for alpha 1-antitrypsin (alpha 1AT, p = 0.03) and orosomucoid (p = 0.02) in the TPN group. Nonacute-phase proteins reached a nadir at day 10 in the TPN group and increased in the TEN group; significant differences between TEN and TPN groups appeared for albumin (p = 0.004) and retinol-binding protein (RBP, p = 0.03); alpha 2-macroglobulin (alpha 2M) approached significance at day 10 (p = 0.07). When change from baseline values was compared, day 10 increases in alpha 2M were significantly higher (p = 0.04) in the TEN group. These data suggest that postinjury TEN attenuates reprioritization of hepatic protein synthesis in patients sustaining major trauma.     

老年胃癌患者术后早期肠内营养与肠外营养疗效的比较

目的探讨老年患者胃癌切除术后早期肠内营养的效果。方法回顾分析 1999年 7月至 2 0 0 2年 6月间 5 2例老年患者胃癌切除术后早期营养支持临床资料 ,本组 5 2例患者中 ,早期给予肠内营养 (earlyenteralnutrition ,EEN) 2 7例 ,术后第 1天开始TPN支持 2 5例。结果术后平均住院日EEN组较肠外营养 (totalparenteralnutrition ,TPN)组短 (16 3dvs 2 1 3d ,t=4 6 814 ,P <0 0 1) ,平均住院费用 /药物费用EEN、TPN组分别为 (10 5 6 3/ 4 15 1元vs136 4 0 / 6 12 6元 ,P <0 0 5 )。并发症发生率EEN组少于TPN组 ,差异有显著性 (P <0 0 5 )。TPN组治疗后肝功的碱性磷酸酶的水平高于治疗前 ,差异有显著性 (P <0 0 5 )。结论老年胃癌患者术后早期EEN支持可减少并发症 ,对肝功能影响小 ,费用低。     

A comparison study between early enteral nutrition and parenteral nutrition in severe burn patients

This clinical study compares effects between enteral nutrition and parenteral nutrition in the early stage of severe burns. Nineteen cases of severe burn patients were divided randomly into total enteral nutrition group (TEN) and total parenteral nutrition group (TPN). Plasma motilin, malondialdehyde (MDA), superoxide dismutase (SOD), endotoxin, tumor necrosis factor (TNF), serum gastrin, diamine oxidase (DAO), and urine lactulose/mannitol ratio (L/M) was determined on post burn day (PBD) 1, 4, 8, 14, respectively. The results showed that serum gastrin, plasma motilin, and SOD were significantly higher in TEN than in TPN on PBD4, 8 (p<0.05-0.01). Plasma MDA was obviously lower in TEN than in TPN on PBD4, 8 (p<0.01). Plasma endotoxin was significantly lower in TEN than in TPN on PBD4, 8 (p<0.01). Plasma TNF were significantly lower in TEN than in TPN on PBD4, 8, 14 (p<0.01). The level of serum DAO and urine L/M ratio in TEN was obviously lower than in TPN on PBD4 and 8, respectively (p<0.05-0.01). A positive correlation between L/M and DAO, MDA, TNF (r=0.5822-0.7598, p<0.05-0.01), and a negative correlation between L/M and SOD (r=-0.7771, p<0.01), and a positive correlation between plasma endotoxin and TNF, MDA (r=0.9038 and 0.6705, p<0.05-0.01) were found. These results indicate that enteral nutrition was a more effective route to preserve gastrin secretion and motility of gastrointestinal tract, lower intestinal ischemia and reperfusion injury, reduce intestinal permeability, decrease plasma endotoxin and inflammatory mediators, and maintain mucosa barrier function. Whenever gastrointestinal function permits, enteral nutrition was superior to parenteral nutrition early after burn.     

TEN versus TPN following major abdominal trauma--reduced septic morbidity

Recent animal models suggest that enteral feeding (TEN) compared to parenteral nutrition (TPN) improves resistance to infection. This prospective clinical trial examined the impact of early TEN vs. TPN in the critically injured. Seventy-five patients with an abdominal trauma index (ATI) greater than 15 and less than 40 were randomized at initial laparotomy to receive either TEN (Vivonex TEN) or TPN (Freamine HBC 6.9% and Trophamine 6%); both regimens contained 2.5% fat, 33% branched chain amino acids, and had a calorie to nitrogen ratio of 150:1. TEN was delivered via a needle catheter jejunostomy. Nutritional support was initiated within 12 hours postoperatively in both groups, and infused at a rate sufficient to render the patients in positive nitrogen balance. The study groups (TEN = 29 vs TPN = 30) were comparable in age, injury severity and initial metabolic stress. Jejunal feeding was tolerated unconditionally in 25 (86%) of the TEN group. Nitrogen balance remained equivalent throughout the study period, at day 5 TEN = -0.3 +/- 1.0 vs. TPN 0.1 +/- 0.8 gm/day. Traditional nutritional protein markers (albumin, transferrin, and retinol binding protein) were restored better in the TEN group. Infections developed in 5 (17%) of the TEN patients compared to 11 (37%) of the TPN group. The incidence of major septic morbidity was 3% (1 = abdominal abscess) in the TEN group contrasted to 20% (2 = abdominal abscess, 6 = pneumonia) with TPN. This clinical study demonstrates that TEN is well tolerated in the severely injured, and that early feeding via the gut reduces septic complications in the stressed patient.     

营养治疗途径对急性胰腺炎患者胰床感染的影响

目的探讨重症急性胰腺炎时营养治疗途径对胰床感染的影响。方法３８例急性胰腺炎患者随机分成全胃肠道外营养（ＴＰＮ）２３例,及全肠内营养（ＴＥＮ）１５例两组,对其胰床感染及肠道细菌移位情况进行观察。结果ＴＰＮ组胰床感染率５７１％,而ＴＥＮ组仅为１６７％,胰床感染病例肠系膜淋巴结细菌易位率达８５７％,远高于非胰床感染者（３１６％）（Ｐ＜０．０５）。结论胰床感染菌源自于肠道。胰腺炎患者早期行肠内营养对预防胰床感染及其并发症的发生具有重要作用。     

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目的 从临床经济学角度比较胰十二指肠切除术后肠内营养与肠外营养治疗费用的差别，评价早期肠内营养支持作用。方法 回顾分析1999年7月至2001年6月间32例胰十二指肠切除术后早期营养支持临床资料，其中早期肠内营养（EEN）组11例，术后第1天开始EEN支持；肠外营养组（TPN）21例。结果 术后平均住院日EEN组较TPN组为短（25.0天vs36.3天，P＜0.01），且平均费用明显少于TPN组（28368元vs40494元，P＜0.01）。并发症发生率EEN组虽少于TPN组，但无统计学差异（P＞0.05）。费用效果分析及敏感性分析提示EEN较TPN优越。结论 胰十二指肠切除术后EEN支持可减少并发症，并有更好的费用效果比。     

胃癌手术后早期肠内营养对T淋巴细胞亚群的影响

目的 探讨胃癌病人手术后早期肠内营养对T淋巴细胞免疫功能的影响。方法 30例胃癌根治术病人随机分成3组：对照组、肠外营养组（TPN组）、肠内营养组（TEN组）,分别给予普通静脉输液、全肠外营养及全肠内营养8d。术前、术后第1、3、6、9天以碱性磷酸酶－抗碱性磷酸酶（APAAP）法测定T淋巴细胞亚群（CD3、CD4、CD8）变化。结果 对照组和TPN组术后CD3、CD4阳性细胞数及CD4／CD8比值明显降低,CD8阳性细胞数明显升高。TNE组术后第1天CD3、CD4阳性细胞数及CD4／CD8比值明显降低,但自术后第3天起即开始上升,并逐渐恢复至术前水平。术后第3、6、9天CD3、CD4阳性细胞数及CD4／CD8比值明显高于对照组和TPN组（P＜0.05),而CD8阳性细胞数明显低于对照组和TPN（P＜0.05),术后第9天时CD4／CD8比值明显高于术前水平。结论 早期肠内营养可纠正胃癌手术后病人的T淋巴细胞免疫抑制状态,促进T淋巴细胞免疫功能的恢复。     

Enteral vs parenteral nutrition after major abdominal surgery: an even match

HYPOTHESIS: Immediate enteral feeding following major abdominal surgery reduces postoperative complications and mortality when compared with parenteral nutrition. DESIGN: A prospective multicenter randomized trial. SETTING: A university hospital department of digestive surgery. PATIENTS AND INTERVENTIONS: Two hundred forty-one malnourished patients undergoing major elective abdominal surgery were randomly assigned to receive, after surgery, either enteral (enteral nutrition group: 119 patients) or parenteral nutrition (total parenteral nutrition group: 122 patients). The patients were monitored for postoperative complications and mortality. RESULTS: The rate of major postoperative complications was similar in the enteral and parenteral groups (enteral nutrition group: 37.8%; total parenteral nutrition group: 39.3%; P was not significant), as were the overall postoperative mortality rates (5.9% and 2.5%, respectively; P was not significant). CONCLUSION: The present study failed to demonstrate that enteral feeding following major abdominal surgery reduces postoperative complications and mortality when compared with parenteral nutrition.     

Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis.

This two-part meta-analysis combined data from eight prospective randomized trials designed to compare the nutritional efficacy of early enteral (TEN) and parenteral (TPN) nutrition in high-risk surgical patients. The combined data gave sufficient patient numbers (TEN, n = 118; TPN, n = 112) to adequately address whether route of substrate delivery affected septic complication incidence. Phase I (dropouts excluded) meta-analysis confirmed data homogeneity across study sites, that TEN and TPN groups were comparable, and that significantly fewer TEN patients experienced septic complications (TEN, 18%; TPN, 35%; p = 0.01). Phase II meta-analysis, an intent-to-treat analysis (dropouts included), confirmed that fewer TEN patients developed septic complications. Further breakdown by patient type showed that all trauma and blunt trauma subgroups had the most significant reduction in septic complications when fed enterally. In conclusion, this meta-analysis attests to the feasibility of early postoperative TEN in high-risk surgical patients and that these patients have reduced septic morbidity rates compared with those administered TPN.