早期肠内营养对胃癌术后近期免疫和营养状况的影响

目的:比较早期肠内(EN)与肠外营养(PN)对胃癌术后免疫和营养状况的影响.方法:将72例胃癌病人随机分为EN组26例、PN组26例及常规输液(对照)组20例.术后24 h开始给予EN或PN,分别检测术前和术后第9天营养和免疫指标,并观察术后严重并发症及肠功能的恢复.结果:EN组和PN组术后体质量、前清蛋白、清蛋白、IgG、IgM及IgA均显著高于对照组(P＜0.05).而EN组与PN组间差异无显著性意义;EN组、PN组术后CD3 、CD4 、CD4 /CD8 均显著高于对照组(P＜0.01),并且EN组术后CD4 、CD4 /CD8 亦显著高于PN组(P＜0.05);EN组胃肠功能恢复时间明显短于PN组和对照组(P＜0.001).结论:早期肠内营养可明显改善胃癌术后近期的营养和免疫状况,在术后细胞免疫和肠功能恢复方面明显优于肠外营养.

Effect of early enteral nutrition on postoperative immune and nutritional status in patients with gastric carcinoma

Objective: To compare the effects of early enteral and parenteral nutrition on immune and nutritional status in patients after surgery for gastric carcinoma.Methods: 72 patients were randomly divided into enteral(EN,n=26), parenteral(PN,n=26) and control(n=20) groups. Patients in EN and PN groups were given nutrition support from postoperative day 1. Nutritional and immune parameters were detected on the day before operation and postoperative day 9.And complications and restoring time of intestinal movement were observed.Results: The postoperative levels of BW, PA,ALB, IgGIgM and IgA in EN or PN group were significantly higher than that in control group(P<0.05) and there were no statistical differences between EN and PN groups. The postoperative percentage of CD3~( ),CD4~( ),CD4~( )/CD8~( ) in EN or PN group was significantly higher than that in control group(P<0.01).Moreover, the postoperative levels of CD4~( ) and CD4~( )/CD8~( ) in EN group were higher than that in PN group(P<0.05). The restoring time of intestinal movement was significantly decreased in EN group comparing with PN or control group(P<0.001).Conclusion: Early enteral nutrition can improve nutritional and immune status of postoperative gastric cancinoma patients which is better than parenteral nutrition in cellular immunity and restoring of intestinal movement.