进展期胃癌患者术后联合应用早期肠内营养与肠外营养的临床研究

目的观察联合应用早期肠内营养与肠外营养对进展期胃癌术后患者营养状况和免疫功能的影响。方法将60例进展期胃癌患者分为联合应用早期肠内营养与肠外营养组（EPN，n=30）和肠外营养组（PN，n=30）。EPN组患者于术后第1天起肠内给予瑞素（500mL），肠外给予卡文（1440mL）；PN组术后第1天起给予卡文（1920mL）。所有患者均于术前第1天和术后第8天分别检测营养指标（血清白蛋白、前白蛋白、总蛋白）、体液免疫指标（IgG、IgA、IgM）、应激指标C反应蛋白、补体C3、C4浓度，并观察记录术后肠道功能恢复时间，住院时间及感染性并发症的发生情况。结果EPN组患者术后肠道功能恢复得更早，住院时间更短，并发症的发生率明显低于PN组（P〈0．05）；术后第8天，EPN组总蛋白、白蛋白、前白蛋白、IgM与PN组比较，差异无统计学意义（P〉0．05），IgG、IgA、C3、C4升高明显，接近或超过术前水平；CRP水平明显下降，与PN组比较，差异有统计学意义（P〈0．05）。结论联合应用早期肠内营养与肠外营养可促进患者术后肠道功能的恢复，减少住院时间，且并发症少，而且具有免疫调节作用，可作为进展期胃癌术后的首选营养支持方法。

Clinical research on early enteral nutrition combined parenteral nutrition in the postoperative patients with advanced gastric cancer

Objective To observe the effect of＇ early enteral nutrition combined parenteral nutrition on the nurture and immune function in the postoperative patients with advanced gastric cancer. Methods Sixty postoperative patients with advanced gastric cancer were randomly divided into early enteral nutrition combined parenteral nutrition group （ EPN, n = 30） and parenteral nutrition group （PN, n = 30）. Patients of EPN received RU ISU enteral nutrition （500 ml） by nose -duodenum tube at 1 day after operation and Kabi parenteral nutrition （1 440 ml） ;Patients of PN received Kabi parenteral nutrition （1 920 mL） at one day after operation. Patients of the two groups were checked for levels of TP, ALB, PA, IgG, IgA, IgM, CRP, C3 and C4 on the preoperative 1 st and the post operative 8th day. The recovery of gastrointestinal function, the time for hospital stay and the postoperative infectious complication were observed. Results The recovery of gastrointestinal in the EPN group was earlier than was in the PN group;the time for hospital stay was less than was in the PN group;the incidence of complication was obviously lower in the EPN group than was in the PN group. On the 8th day, there were no statistical differences in the levels of TP,ALB, PA, IgM between two groups （ P 〉 0.05 ）, but IgG, IgA, C3 and C4 increased obvi- ously, close to or more than preoperative levels. The level of CRP significantly decreased, and there were statistical differences in the lev- els of IgG, IgA, C3 and C4, CRP between two groups （ P 〈 0.05 ）. Conclusion Using both PN and EN can help gastrointestinal move- ment to decrease the occurrence of complications and the time tor hospital stay, and can improve the immune function. So, it is a preferred method of nutritional support for patients With advanced gastric cancer after operation at prophase.