胆汁回输联合早期肠内营养对良性梗阻性黄疸患者术后血清CRP及免疫功能的影响

目的 探讨胆汁回输联合早期肠内营养（early enteral nutrition,EEN）对良性梗阻性黄疸患者术后血清C反应蛋白（C-reactive protein,CRP）及免疫功能的影响.方法 将57例术后行胆汁外引流的良性梗阻性黄疸患者随机分为胆汁回输组（A组）、EEN组（B组）、胆汁回输联合早期肠内营养组（联合组,C组）,分别于术前1 d,术后第1、3、7天晨同一时间空腹抽取外周静脉血10 mL,测定CRP、C3、C4、IgA、IgM、IgG、T淋巴细胞亚群（CD3＋,CD4＋,CD8＋,CD4＋/CD8＋值）.观察患者病情转归情况,统计术后感染发生率.结果 联合组患者术后血清CRP水平低于EEN组及胆汁回输组（P＜0.05）.联合组与EEN组相比较,其T淋巴细胞功能恢复更迅速、恢复程度更高（P＜ 0.05）,免疫球蛋白及补体系统术后恢复较快（P＜0.05）;联合组与单纯胆汁回输组比较,两组术后免疫球蛋白及补体系统的恢复,在速度和程度上的差异不具有统计学意义（P＞ 0.05）.联合组术后感染发生率低于EEN组及胆汁回输组（P＜ 0.05）.结论 胆汁回输联合早期肠内营养能有效改善良性梗阻性黄疸患者的体液及细胞免疫功能,减轻术后炎症反应,降低术后感染发生率,促进术后快速康复.

The influence of bile reinfusion combined with EEN on serum CRP and immunologic function for postoperative patients with obstructive jaundice

Objective To investigate the influence of bile reinfusion combined with early enteral nutrition （EEN） on serum C-reactive protein （CRP） and immunologic function in patients with obstructive jaundice after operations. Methods Fifty-seven cases with obstructive jaundice who had received biliary tract external drainage were randomly divided into bile reinfusion group （n=19）, early enteral nutrition （EEN） group （n=20） and bile reinfusion combined with EEN group （n=18）. CRP, complementC3 and C4, immunoglobulin IgA, IgM, lgG, and T lymphocyte subsets （CD3＋, CD4＋, CD8＋, CD4＋/CD8＋） were measured on the day before operation and on the postoperative day 1, 3, 7. At the same time the incidence of infection and other complications after operation were calculated and analyzed. Results The serum level of CRP in bile reinfusion combined with EEN group was lower than those of EEN group and bile reinfusion group （P〈0.05）. Compared with EEN group, the recovery degree of the function of T lymphocyte cells was higher and more rapidly in reinfusion combined with EEN group （P〈O.05）. The recovery of immunoglobulin and complement system after operation also was apparent （P〈0.05）. Compared with bile reinfusion group, both the difference of recovery of immunoglobulin and complement system in the speed and extent was not statistically significant （P〉0.05）. Compared with EEN group and bile reinfusion group respectively, the infection rate of bile reinfusion combined with EEN group was lower （P〈0.05）. Conclusion Bile reinfusion combined with EEN enhance the humoral and cellular immune function in patients with obstructive jaundice after operations. Beyond that, this treatment can reduce the level of inflammatory responses and reduce the incidence of postoperative infection. So it can promote postoperative recovery of patients.