肠内营养支持对消化道肿瘤术后患者营养状况和免疫功能的影响

目的：研究术后早别应用含膳食纤维肠内营养支持对消化道肿瘤术后患者机体营养状况和免疫功能的影响。方法：148例合并营养不良的消化道肿瘤患者分为3组，肠内营养组（EN组）60例采用以含膳食纤维为主的肠内营养；肠外营养组（PN组）60例行标准TPN支持；常规组28例常规输液及逐渐过渡饮食。观察临床表现，并测定治疗前后患者的营养和免疫指标。结果：肠功能恢复时间EN组明显短于PN组和对照组（P〈0．01）；各项生化指标治疗前后3组均差异无显著性意义；营养及各免疫指标比较，除TP、CD8^＋外，EN、PN组均高于对照组（P〈0．05或0．01），且EN组CD4^＋、CD4^＋／CD8^＋高于PN组（P〈0．05）。结论：早期应用含膳食纤维肠内营养可明显改善消化道肿瘤术后患者的营养和免疫状况，术后细胞免疫和肠功能恢复方面明显优于肠外营养。

Effect of Postoperative Early Enteral Nutrition on Nutritional Status and Immune Function of the Patients with Gastrointestinal Carcinoma

Objective: To study the effect of postoperative early enteral nutrition support with dietary fibers on the immune function and nutritional status of the patients with gastrointestinal cancer. Methods: 148 patients were randomly divided into enteral (EN, n=60), parenteral (PN, n=60) and control (n=28) groups. The EN group was treated with EN including dietary fibers, and the PN group received normal TPN, and the control group received transfusion. The clinical manifestation and immune parameters were evaluated before and after the treatment. The complications and recovery of gastrointestinal functions were carefully observed and recorded simultaneously. Results: The restoring time of intestinal movement was significantly shortened in EN group as compared with PN or control groups (P<0.01). There was no evidence of damage of EN to the renal and liver function. The levels of BW, PA, Alb, IgG, IgM and IgA in EN or PN groups were significantly higher than in control group ((P<)(0.05)), but there was no statistical difference between EN and PN groups. The percentage of CD3~+, CD4~+, (CD4~+/CD8~+ )in EN or PN group was significantly higher than that in control group (P<0.01). Moreover, the levels of CD4~+ and CD4~+/CD8~+ in EN group was higher than that in PN group (P<0.05). Conclusion: Early EN with dietary fibers can improve nutritional and immune statuses of postoperative patients with gastrointestinal carcinoma and is better than PN in cellular immunity and recovery of intestinal movement.