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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。     

消化道恶性肿瘤患者术后早期营养支持的临床研究

目的探讨消化道恶性肿瘤术后早期肠内营养（EEN）＋肠外营养（PN）可行性。并将其与完全胃肠外营养（PN）对患者营养状况和免疫功能的影响进行比较。方法将2002年10月-2004年3月在本院普外科行择期消化道恶性肿瘤手术患者随机分为EEN＋PN组（22例）和TPN组（24例）,于术后24h开始营养治疗。术前、术后第1、3、7天测定血前白蛋白（PA）、白蛋白（ALB）和血色素（Hb）水平;术前、术后第7天测定血IgA、IgG、IgM、T淋巴细胞亚群CD3、CD4、CD8及CD4／CD8水平;术后第1～7天每日测定氮平衡（NB）。比较两组上述指标在术后的差异。结果两组问在术前、术后第1、3、7天测定的血PA、ALB、Hb及术后第1-7天测定的NB比较．差异均无显著性（P〉0．05）。术后第7天EEN＋PN组CD3、CD4水平明显高于TPN组（P〈0．05,P〈0．01）。结论EEN＋PN是腹部术后安全有效的营养途径。rh于EEN＋PN在改善免疫功能方面明显优于TPN．因此它应成为消化道肿瘤患者术后首选的营养方式。     

参麦注射液对胃癌患者术后营养和免疫的影响

目的:观察参麦注射液联合肠内营养对胃癌患者术后营养状况和免疫功能的影响。方法:将58例胃癌患者半随机分为肠外营养组19例、肠内营养组19例、观察组(参麦注射液联合肠内营养)20例,术前第1d及术后第1、5、9d检测肱三头肌皮褶厚度、总蛋白、白蛋白、前白蛋白、淋巴细胞总数、T淋巴细胞亚群(CD3、CD4、CD8)、免疫球蛋白(IgG、IgM、IgA),观察肠道功能恢复及并发症等情况。结果:观察组在术后第9d血清CD3、CD4、CD4/CD8、前白蛋白均比肠外营养组和肠内营养组相应指标显著增高(P0.05),观察组IgA高于肠外营养组(P0.05),观察组术后下床活动时间、住院时间均比肠外营养组和肠内营养组缩短(P0.05)。结论:参麦注射液联合肠内营养支持较常规肠外营养和肠内营养支持能更好地改善患者营养状态和免疫功能。     

早期肠内营养对食管癌患者术后免疫功能和临床结局的影响

目的探讨早期肠内营养（EEN）对食管癌术后患者机体免疫功能和临床结局的影响。方法选取2011年3月至2012年7月在哈尔滨医科大学附属第四医院胸外科行根治性手术治疗的食管癌患者,采用信封法随机分为术后早期肠内营养组（EEN组,30例）和术后按传统治疗方案给予全肠外营养组（TPN组,30例）,两组均行营养支持7d。两组患者分别于术前1d和术后第1、3、7天检测免疫学指标：CD3＋、CD4＋、CD8＋、CD4＋CD8＋比值;营养指标：血清白蛋白（ALB）和前清蛋白（PA）水平。并记录术后首次排气时间、术后住院时间、住院总费用及术后并发症。结果EEN组和TPN组患者术后首次排气时间[（66．5±7．3）h比（75．1±6．8）h,P=0．000],住院时间[（7．8±1．1）d比（9．3±1．3）d,P=0．000]和住院总费用[（3．62±0．38）万元比（3．97±0．40）万元,P=0．001]比较,差异均有统计学意义。两组术后并发症发生率的差异无统计学意义[13．3％（4／30）比20．0％（6／30）,P=-0．488]。术后第3和第7天EEN组患者CD3’、CD4’、CD4＋／CD8＋、ALB和PA均明显高于TPN组（均P〈0．05）：而CD8＋水平显著下降,与TPN组相比,差异亦有统计学意义（尸〈0．05）。结论早期肠内营养用于食管癌术后患者可促进胃肠道功能早期恢复,改善患者的营养状态,降低对免疫功能影响,加速患者的康复。     

围手术期免疫增强型肠内营养剂对全胃切除患者的影响

目的探讨全胃切除患者围手术期免疫增强型肠内营养支持对机体营养状态,免疫功能及炎症反应的影响。方法选择进展期胃癌根治性全胃切除患者48例,随机分为两组:围手术期肠内营养组(实验组,24例)和术后肠内营养组(对照组,24例)。实验组术前5d及术后8d给予免疫增强型肠内营养剂,术前未行常规肠道准备。对照组只在术后给予8d,术前常规行肠道准备。两组患者于术前1d及术后第1天、第8天分别抽取外周血测定血清总蛋白、白蛋白、IgA、T淋巴细胞亚群(CD4、CD4/CD8)、CRP和TNF-α。结果术中见两组患者肠道清洁程度无显著性差异;实验组与对照组比较,实验组血清总蛋白、白蛋白水平较高,随着肠内营养的进行术后实验组增高的更加明显,但无统计学意义;术后实验组CRP、TNF-α水平逐渐降低且同期水平低于对照组,IgA、CD4、CD4/CD8比例逐渐增高且同期水平高于对照组,差异有显著统计学意义,P0.05。结论全胃切除患者围手术期免疫增强型肠内营养支持可明显改善患者的营养状态,增强机体免疫功能,减轻机体炎症反应,促进机体恢复。     

全胃切除术后早期免疫增强型肠内营养支持的应用

目的研究胃癌患者行全胃切除术后早期应用免疫增强型肠内营养对机体恢复、免疫功能及炎性反应的影响。方法选择进展期胃癌患者,行全胃切除、食管空肠Roux—en-Y吻合及行食管空肠袢式吻合（少数几例）病例56例,随机分成2组：免疫增强型肠内营养组（实验组）和常规肠外营养支持组。二组患者均从术后第1天起从营养管道进行肠内和肠外营养,肠内营养组（实验组）使用免疫增强型肠内营养制剂,肠外营养组使用力能脂肪乳剂和复方氨基酸制剂。共1～7d,于术后第1、8天及术前分别抽取外周血测定血清总蛋白、白蛋白、前白蛋白、IgG、IgA、IgM,T淋巴细胞亚群、IL-2。结果两组血清总蛋白、白蛋白、前白蛋白及氮平衡均无显著差异。术后第8天实验组IgG、IgA、IgM、CD3、CIM和CIM／CD8均显著高于PN组（P〈0．05）。结论胃癌根治性全胃切除术患者术后早期免疫增强型肠内营养支持可有效改善患者免疫功能,并能减轻机体的炎症反应。     

大鼠同种异体动脉移植中CD4和CD8淋巴细胞数比值的变化及意义

目的 研究大鼠同种异体动脉移植术前后T淋巴细胞亚群CD4淋巴细胞计数和CD8淋巴细胞计数比值的变化及与急性免疫排斥反应的关系。方法 将45只SD雄性成年大白鼠建立同种异体动脉移植模型,按手术先后随机分为对照组(20只):取未经任何处理新鲜同种异体股动脉作移植。实验组(25只):用经深低温冷冻保存的同种异体股动脉作移植。应用免疫荧光染色技术及流式细胞仪检测2组大鼠术前和术后3、7、14、20d共5个时间组的CD4、CD8阳性细胞百分率,并计算其比值。结果 实验组术后CD4/CD8较术前无明显变化,血管通畅率为100％,未见免疫排斥反应。对照组术后CD4/CD8比值比术前显著增高(P<0.01),20 d时间组的血管通畅率为45％。术后第3天CD4/CD8比值与急性免疫排斥反应程度呈正相关。结论 深低温冷冻保存的大鼠同种异体动脉移植后CD4/CD8比值的变化和术前无明显变化,可作为术后急性免疫排斥反应的免疫学监测指标。     

围术期轻度低温对患者T淋巴细胞亚群免疫功能的影响

目的观察围术期轻度低温对颅脑手术患者T淋巴细胞亚群免疫功能的影响。方法50例ASA Ⅰ或Ⅱ级择期开颅手术患者随机分为轻度低温组(L组)和常温组(W组),每组25例。分别在麻醉前、术后第1天、第5天采静脉血1ml,用流式细胞仪测定T淋巴细胞亚群CD3 、CD4 、CD8 阳性细胞百分率及CD4 /CD8 比值。结果L组患者术后第1天CD3 、CD4 、CD4 /CD8 显著低于术前(P<0.05或P<0.01),W组患者术后第1天CD4 、CD4 /CD8 降低显著(P<0.05)。术后第5天,两组患者的各项指标均已接近术前水平。术后第1天L组CD3 、CD4 、CD4 /CD8 显著低于W组(P<0.05或P<0.01)。结论围术期轻度低温可以抑制机体的T淋巴细胞功能。     

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。     

谷氨酰胺强化肠内营养支持对全胃切除术后营养及免疫功能影响的研究

目的 探讨经胃十二指肠管谷氨酰胺强化肠内营养支持对全胃切除术后营养及免疫功能的影响。 方法 收集2006年10月至2009年2月上海交通大学医学院附属仁济医院普外科接受全胃切除术的72例进展期胃癌病人,随机分为谷氨酰胺强化肠内营养（EN+Gln）组、肠内营养（EN）组和对照组。在术后48h内待一般情况稳定后即开始给予肠内营养。观察肛门排气恢复时间、术后并发症发生率及住院时间,分别于术前1d、术后3d和12d检测总蛋白、白蛋白、前白蛋白、转铁蛋白,术后7d检测外周血NK细胞、CD4+T细胞、CD8+ T细胞和免疫球蛋白IgM、IgG。 结果 EN+Gln组与EN组术后并发症发生率及住院时间均低于对照组。术后第3天3组病人总蛋白、白蛋白、前白蛋白及转铁蛋白均较术前明显下降,且对照组总蛋白、白蛋白及转铁蛋白下降幅度更大（P<0.05）,术后第14天时EN+Gln组与EN组的总蛋白、白蛋白、前白蛋白及转铁蛋白水平明显高于对照组（P<0.05）。术后第7天EN+Gln组CD4+T细胞、NK细胞百分比和IgM、IgG较术前明显升高,且较EN组和对照组同期显著升高（P<0.05）。 结论 全胃切除术病人围手术期谷氨酰胺强化肠内营养支持有助于改善营养和免疫状态、促进术后恢复,减少并发症发生率和缩短住院时间。     

腹部大手术后早期肠内与肠外营养随机对照研究

20例腹部大手术病人随机分为两组。术后1~8天分别接受肠内营养和肠外营养。结果发现:肠内营养组体重丢失明显少于肠外营养组;日均氮平衡明显高于肠外营养组;血清总蛋白、白蛋白及转铁蛋白水平与肠外营养组相比无明显差别;术后并发症明显少于肠外营养组;治疗费用明显低于肠外营养组。以上结果表明术后早期肠内营养与肠外营养相比安全可靠、简便易行、疗效优良、费用低廉,值得在临床上应用。     

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.     

Role of enteral immunonutrition in patients with gastric carcinoma undergoing major surgery

OBJECTIVE: To evaluate the influence of postoperative immunonutrition on immune and nutritional parameters in patients with gastric carcinoma. METHODS: From September 2002 to August 2003, 40 patients with gastric carcinoma who had undergone major surgery were randomly divided into an immunonutrition group and standard nutrition group, each of 20 patients. On postoperative Day 2, patients in the standard nutrition group received a standard enteral formula, while those in the immunonutrition group received an enteral formula enriched with glutamine, arginine and omega-3 fatty acids. Nutritional support was continued for 7 days. Blood samples were obtained to determine plasma albumin, prealbumin and transferrin on Days 0, 5 and 9. On Days 0, 1 and 9, blood samples were collected to detect immunoglobulin (Ig) A, IgG, IgM, CD4 and CD8 cell counts, the ratio of CD4/CD8, interleukin (IL)-2, IL-6 and tumour necrosis factor (TNF)-alpha, respectively. RESULTS: There were no significant differences between the two groups in protein and immune parameters preoperatively and no significant differences in management perioperatively. No serious adverse effects were recorded with the two formulas. Postoperative procedures were smooth in both groups. On Day 9, serum levels of prealbumin and transferrin were higher in the immunonutrition group than in the standard nutrition group (p<0.01). After 7 days' nutritional support, patients in the immunonutrition group had higher levels of immunoglobulin, CD4 cell counts, CD4/CD8 ratio and IL-2 than those in the control group, whereas IL-6 and TNF-alpha levels were significantly lower in the immunonutrition group. CONCLUSION: Compared with standard enteral nutrition, enteral immunonutrition can improve defence mechanisms and modulate inflammatory action after major elective surgery for gastric carcinoma.     

Route of nutritional supply influences local, systemic, and remote organ responses to intraperitoneal bacterial challenge.

OBJECTIVE: The authors' aim was to investigate whether antecedent nutritional routes influence immune responses after surgical insult. SUMMARY BACKGROUND DATA: Total parenteral nutrition (TPN) may influence host responses to infection. To the best of the authors' knowledge, however, no study has focused on the mechanisms underlying the influence of nutritional route on local, systemic, and remote organ (lung) responses after surgical insult. METHODS: Sixty-eight rats were divided into TPN and total enteral nutrition (TEN) groups. The two groups received identical nutrients for 7 days and were then challenged intraperitoneally with 3 x 10(8) Escherichia coli. In the first experiment, the rats were observed for survival. In the second experiment, the rats were killed before (0 hours) challenge or 2 or 6 hours after challenge. Peritoneal exudative cells (PEC) and bronchoalveolar cells (BALC) were harvested and cultured in vitro. Colony-forming units of bacteria in the peritoneal lavage fluid (PLF) were determined. Tumor necrosis factor (TNF), interleukin-1 alpha (IL-1 alpha), interferon-gamma (IFN-gamma) levels in serum, PLF, bronchoalveolar lavage fluid (BALF), and cell culture supernatants were measured. RESULTS: The 48-hour survival rate was higher in TEN than in TPN rats. Local immunity was depressed in the TPN group. Bacterial colony counts in PLF were significantly higher in the TPN group than in the TEN group after challenge. The number of PECs was significantly lower, and at 2 hours, local cytokine (TNF and IL-1 alpha) responses were diminished in the TPN group compared with the TEN group at 2 hours. The number of PECs showed a significant positive correlation with levels of local cytokines in the TEN group but not in the TPN group. Elevation of local IFN-gamma was significant from 0 to 6 hours in the TEN group but not in the TPN group. In vitro production of TNF by PEC was impaired in the TPN rats before challenge. Remote organ (lung) responses were suppressed in the TPN group. The number of BALCs and the TNF levels in BALF declined significantly between 0 and 2 hours in the TEN group but not in the TPN group. Interferon-gamma levels in BALF were higher in the TEN group than in the TPN group at 2 hours. Systemic cytokine responses were disturbed in the TPN group. Production of systemic TNF was greater, but the IFN-gamma response was diminished in the TPN group compared with the TEN group after intraperitoneal bacterial challenge. CONCLUSION: Local, systemic, and remote organ (lung) immune responses to intraperitoneal bacterial challenge are suppressed in TPN-treated animals, leading to poor survival after challenge. Enteral nutrition before surgical insult may enhance host immune responses after the insult as compared to parenteral nutrition.     

免疫增强型肠内营养制剂对老年胃癌术后化疗免疫功能的影响分析

目的观察免疫增强型肠内营养制剂对老年胃癌患者术后免疫功能以及营养状态的影响,为此类患者的有效治疗方法提供参考。 方法选择2014年1月至2015年2月胃癌手术后进行化疗的80例患者,按照随机数表法分为对照组（采用常规的肠内营养制剂）和观察组（采用免疫增强型肠内营养制剂）,各40例。比较两组患者的免疫球蛋白、T细胞亚群、化疗之后营养指标以及住院天数、排便时间以及首次排气时间。 结果治疗后观察组患者的IgM、IgG、IgA上升幅度显著优于对照组,CD3、CD4、CD8明显优于对照组,TF、PA、ALB、Hb均高于对照组,差异有统计学意义（P<0.05）;观察组患者住院天数、排便时间以及首次排气时间明显短于对照组,差异有统计学意义（P<0.05）。 结论胃癌术后化疗通过免疫增强型肠内营养制剂能够显著改善免疫功能,缩短患者的住院时间,值得在临床上推广。     

食管贲门癌术后早期肠内营养支持的临床研究

目的　探讨食管贲门癌术后 12h行早期肠内营养支持的有效性和安全性。方法　将2 0例食管贲门癌患者随机分为两组 ,每组 10例 ,分别于术后 12h予以等氮和等热卡的肠内和肠外营养支持 ,持续 8d。结果　早期肠内营养支持组在支持前后白蛋白较对照组 (肠外营养 )明显升高 ,且于术后第 5天即可达到正氮平衡 ,无明显的肝肾功能影响。结论　食管贲门癌术后 12h进行早期肠内营养支持是安全有效的     

胃肠外营养添加精氨酸对胃癌术后患者淋巴细胞免疫功能的作用

为探讨胃肠外营养（ＴＰＮ）添加精氨酸（Ａｒｇ）对胃癌术后患者淋巴细胞免疫功能的影响及意义,对３６例胃癌术后患者进行了ＴＰＮ支持的前瞻性研究,检测常规ＴＰＮ和ＴＰＮ添加Ａｒｇ支持前后患者的Ｔ淋巴细胞亚群、ＮＫ细胞活性、ＩＬ２和ＣＤ２５水平变化。结果：常规ＴＰＮ支持前后患者的Ｔ淋巴细胞亚群、ＮＫ细胞活性、ＩＬ２和ＣＤ２５水平变化无明显差异,而ＴＰＮ添加Ａｒｇ支持后患者的ＣＤ４、ＣＤ４／ＣＤ８比值、ＮＫ细胞活性和ＩＬ２水平均明显增加（Ｐ＜０．０５）。本研究结果显示：常规ＴＰＮ不能纠正胃癌术后患者的淋巴细胞免疫功能抑制,但ＴＰＮ添加Ａｒｇ则可促进ＩＬ２生成增加,ＮＫ细胞活性增强,改善了胃癌术后患者的淋巴细胞免疫功能,提示ＴＰＮ添加Ａｒｇ有免疫促进作用