进展期胃癌应用肠内营养的临床观察

目的 探讨进展期胃癌患者应用肠内营养对术后营养状况、炎症反应及免疫功能的影响.方法 遵照NRS-2002进行营养风险筛查,总分≤3分无营养风险的69例分为传统治疗组（对照组,34例）和肠内营养组（35例）：对照组按传统方法术前3天流质饮食,术前禁食12 h,术后禁食3 d、补充液体及所需热量,胃肠功能恢复后进半流质;肠内营养组在对照组基础上口服短肽型肠内营养制剂300 g/d,术前4 h停用,术后24 h即开始鼻饲.两组分别于术前3天、术后第4天及术后第8天监测营养指标、炎症反应、免疫指标和手术并发症发生率.结果 两组术前基本情况及营养代谢与免疫指标比较,差异均无统计学意义（均P＆gt;0.05）.术后两组各项指标除血红蛋白差异无统计学意义外,肠内营养组的体重、体质量指数、白蛋白、前白蛋白、转铁血红蛋白、C反应蛋白、血小板计数、WBC、IgG、IgA、IgM、C3、C4均优于对照组（均P＜0.05）,术后并发症发生率差异也有统计学意义（P＜0.05）.结论 进展期胃癌患者围手术期应用肠内营养,可改善患者营养状况,提高机体免疫功能,降低机体对手术创伤的炎症反应及术后并发症,是一简便、价廉、安全的营养支持疗法.

Clinical research of enteral nutrition in 35 advanced gastric cancer patients

Objective To explore the effects of enteral nutrition upon postoperative nutritional status, inflammatory response and immune function in advanced gastric cancer patients. Methods Nutritional risk screening was performed according to the NRS-2002. A total of 69 patients with scores under 3 and no nutritional risk were randomly divided into the control （n = 34） and enteral nu- trition（n = 35）groups. The control group received the traditional regimen of 3-day liquid diet, 12-hour preoperative fasting, 3-day fasting ＆ adequate postoperative rehydration and semifluid diet upon a re- covery of gastrointestinal function. On the basis of the control group, the enteral nutrition group took short peptide enteral nutrition powder 300 g/d until 4 h pre-operation and started nasal feeding in 24 h post-operation. For each patient, nutrition indices, inflammatory response and immune parameters and the incidence of surgical complications 3d pre-operation, 4d and 8d post-operation were recorded and analyzed. Results Except for hemoglobin, the enteral nutrition group was superior to the control group with regards to body weight, body mass index （BMI）, albumin, prealbumin, transferrin, C-re- active protein, leucocyte, platelet, IgG, IgA, IgM, C3 and C4（P〈0. 05）. And the incidence of post- operative complications also had statistical significance （P〈0. 05）. Conclusions For advanced gastric cancer patients, the perioperative application of enteral nutrition may improve nutritive status and im- mune function, reduce body inflammatory reaction and lower the postoperative complications of surgi- cal trauma. It is a simple, cheap and safe nutrition support therapy.