近端胃切除术后肠内外营养联合应用对血清营养及免疫学指标的影响

对40例经腹行近端胃切除术治疗的胃上部癌患者术后均给予肠外营养，待肠功能恢复后逐步过渡为全量肠内营养，观察术前及术后第1、8天血白蛋白、前白蛋白、转铁蛋白等营养学指标及IgA、IgG、IgM、C3、C4等免疫学指标。平均住院时间14d，肛门排气时间平均（58±6）h。术前、术后血生化及肝肾功能指标无显著改变（P〉0．05）；术后第1天营养指标及免疫指标与术前比较差异有统计学意义（P〈0．05），除IgM术前与术后第1天、IgG术前与术后第8天比较差异无统计学意义外，其他差异均有统计学意义（P〈0．05）。3例（8％）并发症中：膈下感染1例，吻合口瘘2例，经保守治疗后痊愈出院。提示，近端胃切除术后肠内外联合营养支持可改善患者的营养及免疫状态。

Effect of combined enteral and parenteral nutrition on nutritional and immune status of patients after proximal gastrectomy

Parenteral nutrition (PN) was given to 40 patients with upper gastric carcinoma after proximal gastrectomies; and full enteral nutrition (EN) was subsequently given when bowels function recovered.The nutritional indicators including serum albumin ( Alb),prealbumin .(PA) and transferring,and immunological indicators including IgA,IgG,IgM,C3,C4 were measured before and 1st,8th day after operation.The data were processed by software SPSS 13.0.The average length of hospital stay was 14 d and the aerofluxus time was (58 ±6)hours.There were no changes in blood biochemistry,hepatic function and renal function pre- and post-operation( P ＞0.05 ).The nutritional and immune indicators except the IgM in 1 st day after operation were decreased significantly ( P ＜ 0.05 ).The immune indicators except the IgG in 8th day after operation were significantly improved in comparison of those before and 1st day after operation ( P ＜ 0.05 ).Post-operative complications occurred in 3 patients including 1 case of subphrenic infection and 2 cases of anastomotic leakage.After proper treatment,all patients recovered well.Combined application of EN and PN may improve nutrition and immune status of patients after proximal gastrectomy.