消化道肿瘤-T-术后早期肠内营养疗效研究

目的评价消化道肿瘤手术后早期肠内营养的安全性，比较手术后短期应用要素制剂爱伦多的肠内营养与标准肠外营养支持的疗效。方法62例消化道恶性肿瘤手术患者，随机分为对照组、肠外营养组和肠内营养组。手术后第一天开始等热卡、等氮量的肠外或肠内营养支持一周。检测体重、机体测量指标、血浆各内脏蛋白浓度及氮平衡等营养指标，外周血T细胞亚群、NK细胞和NK细胞活性等免疫指标及血清氨基酸谱。结果三组病人术后体重下降分别为4．26±1．03ks、2．04±0．65ke和2．12±o．72kg，对照组与肠外营养组、肠内营养组之间差异有显著性(P<0．05)，后两组之间无差异。术后各内脏蛋白浓度均低于术前，对照组降低最明显，与肠外或肠内营养组之间差异有显著性(P<0．05)，而后两组之间无差异。三组病人平均氮平衡为—8．6±3．12g／d，—4．22±2．02g／d及—3．88±2．35g／d，对照组与肠外或肠内营养组之间差异有显著性(P<0．05)，而后两组之间无差异。手术后各组病人外周血T细胞亚群、NK细胞和NK细胞活性均不同程度下降，但三组之间差异无显著性意义。三组病人血清谷氨酰胺水平明显下降，术后1周对照组和肠外营养组血清谷氨酰胺水平仍处于低水平，而肠内营养组却有一定程度恢复。结论消化道肿瘤手术后早期肠内营养支持是安全、有效的方法，短期肠内营养和肠外营养支持的临床效果基本相同。

The effect of early enteral nutrition in postoperative patients with gastrointestinal cancer

Objective To evaluate the safety and effect of enteral nutrition support at early period after gastroenteric operation. Methods 62 patients with gastrointestinal cancer were divided into three groups randomly: control group, TPN group, and TEN group. Patients in TPN and TEN groups received 7 days nutritional support in isonitrogenous and isocaloric. The peripheral vein blood was sampled before operation and 7 day after that to observe nutritional status and T lymphocyte subsets, NK cells, and NK cell activity. Resalts There were no significant difference in the three groups in albumin and anthropomentric measurement, visceral proteins decreased in three groups in postoperative period, but the values of control group was more seriously than TPN or TEN groups (P<0.05). Mean nitrogen balance: - 8.6 ± 3.12g/day in control group, - 4.22 ± 2.02g/day in TPN group, - 3.88 ± 2.35g/day in TEN group (P<0.05). CD3 ,CD4 ,CD4/CD8, NK cells and NK cell activity decreased in postoperative period in three groups, but there are no significant ditference in three groups. Conelasions Enteral nutrition support at early period after gastroenteric operation is safety and effective.