术前早期肠内营养对老年胃癌患者术后免疫功能及预后的影响

目的 探讨术前早期肠内营养（EEN）对老年胃癌患者术后营养状况、免疫功能及预后的影响。方法 将64例择机行胃癌根治术的患者随机分为观察组和对照组，各32例。观察组分别于术前7天、术后早期给予EEN，对照组仅在术后早期给予相同的EEN。比较患者手术前后营养指标、免疫指标的变化及预后。结果 术前1天，观察组ALB、HB较术前7天明显升高（P<0.05）；术后1天，两组各营养指标均较术前明显下降（P<0.05），但观察组明显高于对照组（P<0.05）；术后7天，两组各营养指标均有不同程度恢复，而观察组ALB、PA及HB水平均明显高于对照组（P<0.05）；术前1天，观察组CD4⁺、CD8⁺、IgG、IgM较术前7天明显升高（P<0.05）；术后1天，两组CD4⁺、CD8⁺、CD4⁺/CD8⁺和IgA、IgG、IgM均明显下降（P<0.05）；术后7天，两组各免疫功能指标均较术后1天升高（P<0.05），而观察组除IgA外，其余免疫指标均与术前7天水平差异无统计学意义，且各免疫指标水平均显著高于对照组（P<0.05）。随访1年，观察组感染的发生率较对照组明显降低（P<0.05）。结论 老年胃癌患者术前及术后给予EEN支持治疗，更有利于改善术后营养状态和免疫功能，减少术后感染，提高手术疗效及预后。

Influence of Early Enteral Nutrition during Preoperative Period on Postoperative Immune Function and Prognosis in Elderly Patients with Gastric Cancer

Objective To explore the influence of early enteral nutrition(EEN) during preoperative period on postoperative immune function and prognosis in elderly patients with gastric cancer.Methods Sixty four elderly patients with gastric cancer who were scheduled to received gastrectomy were randomly divided into two groups. The observation group (n=32) was given EEN at the time of one week before surgery and early period after surgery, and control group(n=32) was given EEN at early period after surgery, respectively. The nutritional status and immune function before and after chemotherapy, and main toxicities were observed.Results At 1^st day before surgery, compared with those at 7^th day before surgery, the levels of ALB,HB in observation group were significantly increased(P<0.05).At 1st day after surgery, compared with those before surgery, there was significant decrease in the level of nutritional indicators in both groups, while those indicators in observation group was significantly higher than those in control group(P<0.05). At 7^th day after surgery, nutritional indicators in both groups had different degree of recovery, and levels of ALB, PA and HB in observation group were significantly higher than those in control group(P<0.05). At 1^st day before surgery, compared with those at 7^th day before surgery, the levels of CD4⁺, CD8⁺, IgG, IgM in observation group were significantly increased(P<0.05). At 1^st day after surgery, CD4⁺, CD8⁺, CD4⁺/CD8⁺ and IgA, IgG, IgM in two groups were significantly decreased(P<0.05). At 7^th day after surgery, immune function indexes increased (P<0.05), while the immune indexes except IgA in observation group had no difference compared with those before surgery, and the levels of immune index were significantly higher than those in control group(P<0.05). After one year follow-up, the incidence of infection in observation group was significantly lower than that in control group (P<0.05).Conclusion EEN during preoperative and postoperative periods in elderly patients with gastric cancer is more advantageous to improve the postoperative nutritional status and immune function, reduce postoperative infection, improve curative effect and prognosis.