胃肠道肿瘤患者术后两种早期营养支持的对比研究

目的:探讨两种营养支持对胃肠道肿瘤患者术后营养状况、免疫水平和预后的影响。方法:将入选患者随机分为肠外营养(PN)组(270例)与肠内营养(EN)组(270例),营养支持均在术后第1天开始,按等热量125 kJ/(kg.d)]和等氮量0.25 g/(kg.d)]进行。观察比较两组的营养情况、细胞免疫情况和转归及预后情况。结果:营养指标方面,术后PN组转铁蛋白水平低于术前,其余指标无明显改变,EN组总蛋白、白蛋白、前白蛋白和转铁白蛋白水平均明显高于术前和PN组(均P<0.05);免疫指标方面,PN组NK细胞水平高于术前,其余指标无明显改变,而EN组术后CD3,CD4,CD8,NK细胞和IL-2受体水平明显高于术前和PN组(均P<0.05);并发症与预后方面,PN组与EN组的总并发症发生率分别为56.3%和28.9%(P<0.05),两组病死率差异无统计学意义(P>0.05)。此外,EN组并发症持续时间,术后感染应用抗生素的时间和平均住院时间均明显短于PN组(均P<0.05)。结论:胃肠道肿瘤患者术后早期EN支持优于PN支持,EN支持能较好地改善患者机体营养状况、提高免疫能力和减少并发症的发生。

Comparison between two early postoperative nutritional supports in patients with gastrointestinal cancer

Objective: To investigate the impacts of different nutritional supports on the nutritional status,immune function and prognosis in patients with the gastrointestinal cancer after surgery. Methods: The enrolled patients were randomly assigned to parenteral nutrition(PN) group(n=270) and enteral nutrition(EN) group(n=270).Both nutritional supports were initiated on the first day after surgery under isoenergetic 125 kJ/(kg·d)] and isonitrogenous 0.25 g/(kg·d)] conditions.The nutritional status,immune function,outcome and prognosis of the two groups were compared. Results: In respect of nutritional parameters,the level of transferrin in PN group decreased but other parameters showed no obvious alterations after operation,while in EN group,the levels of total protein,albumin,pre-albumin and transferrin all increased after operation and were all significantly higher than those of PN group(all P<0.05).In terms of immune function,only the level of NK cells increased and other parameters showed no evident alterations after operation,while in EN group,the levels of CD3,CD4,CD8,NK cells and IL-2 receptor all increased after operation and were all significantly higher than those of PN group(all P<0.05).As for the complications and prognosis,the overall incidence of complications in PN and EN group was 56.3% and 28.9%,respectively(P<0.05),while no significant difference was noted in the mortality rate between the two groups(P>0.05).In addition,the length of time of complications,administration of antibiotics and average hospital stay of EN group were all significantly shorter than those of PN group(all P<0.05). Conclusion: Early postoperative EN support is better than PN support for patients with gastrointestinal cancer.EN support can effectively improve the nutritional status and immune function as well as reduce the incidence of postoperative complications.