EEN+PN方案对直肠癌根治术围手术期患者营养和免疫指标及康复的影响

  目的  探讨早期肠内营养(early enteral nutrition，EEN)+胃肠外营养(parenteral nutrition，PN)方案对直肠癌根治术患者营养指标、免疫功能及术后康复的影响。  方法  选取2019年1月—2020年1月北京大学第三医院延庆医院行直肠癌根治术治疗的90例患者进行回顾性分析。依据营养支持方案不同分为观察组(45例)及对照组(45例)，观察组给予EEN+PN营养支持方案，对照组给予术后全胃肠外营养(total parenteral nutrition，TPN)支持。对比2组患者术后营养指标、免疫功能及术后康复情况。  结果  观察组术后3 d、术后1周ALB、总蛋白(TP)及前白蛋白(PAB)水平均高于对照组(术后3 d:t=3.640、4.529、3.207，均P＜0.05;术后1周:t=2.047、2.550、4.079，均P＜0.05);观察组术后3 d及术后1周时IgG、IgA及补体C4水平均高于对照组(术后3 d:t=2.058、3.649、10.680，均P＜0.05;术后1周:t=2.897、2.154、6.012，均P＜0.05);观察组术后排气、排便时间及住院时间均短于对照组(t=6.010、5.784、4.851，均P＜0.05);2组患者术后并发症发生率比较差异无统计学意义(22.2% vs. 24.4%，χ2=0.104，P>0.05)。  结论  直肠癌根治术给予EEN+PN支持方案可有效改善术后患者营养状态，促进术后康复。 

Effect of EEN and PN scheme on the nutrition indicators,immunological function and rehabilitation in patients undergoing laparoscopic colorectal surgery

  Objective  To explore the effect of early enteral nutrition (EEN) + parenteral nutrition (PN) schemes on the nutritional indicators, immunological function and postoperative rehabilitation in patients undergoing laparoscopic colorectal surgery.  Methods  A total of 90 patients who were admitted in our hospital for laparoscopic colorectal surgery were included in the study and divided into the observation group (45 cases) and the control group (45 cases) according to different nutrition support schemes. The patients in the observation group were given EEN + PN scheme, whereas the patients in the control group were given total parenteral nutrition (TPN) support. The nutritional indicators, immunological function and postoperative rehabilitation in the two groups were compared.  Results  ALB, total protein (TP) and prealbumin (PAB) levels at 3 days and 1 week after operation in the observation group were significantly higher than those in the control group (t value 3 days after operation were 3.640, 4.529 and 3.207, respectively, all P < 0.05; t value 1 week after operation were 2.047, 2.550 and 4.079, respectively, all P < 0.05). IgG, IgA and complement C4 levels at 3 days and 1 week after operation in the observation group were significantly higher than those in the control group (t value 3 days after operation were 2.058, 3.649 and 10.680, respectively, all P < 0.05; t value 1 week after operation were 2.897, 2.154 and 6.012, respectively, all P < 0.05). Exhaustion, defecation and hospitalization time after operation in the observation group were significantly lower than those in the control group (t=6.010, 5.784 and 4.851, respectively, all P < 0.05). The comparison of the occurrence rate of postoperative complications between the two groups was not statistically significant (22.2% vs. 24.4%, χ2=0.104, P>0.05).  Conclusion  EEN + PN support scheme for patients undergoing laparoscopic colorectal surgery can effectively improve the nutritional status and promote postoperative rehabilitation.