围手术期联合应用四君子汤和大黄的早期肠内营养对胃癌术后近期免疫功能的影响

目的评价在围手术期应用中药大黄的基础上,术后早期联合应用四君子汤和肠内营养对胃癌患者免疫功能的影响。方法将40例胃癌手术患者随机分为常规肠内营养组(对照组)和大黄、四君子汤干预肠内营养组(研究组)。研究组术前1天、术后18、36小时,经鼻饲管给予中药大黄,对照组给予相同剂量的生理盐水;两组患者均于术后第36小时开始给予等热量、等氮肠内营养支持至术后第10天,研究组在予以肠内营养的同时,经鼻肠管予以四君子汤治疗,并持续应用至术后第10天,对照组经鼻肠管予以相同剂量的生理盐水。两组分别于术前1天,术后第1、10天检测外周血T淋巴细胞亚群(CD3、CD4、CD8及CD4/CD8),免疫球蛋白(IgA、IgG、IgM)浓度。结果研究组术后10天CD3、CD4、CD4/CD8及IgG水平均显著高于对照组(P<0.05)。结论同手术后单独应用肠内营养相比,围手术期联合应用中药的肠内营养具有显著的细胞免疫增强作用,可有效纠正胃癌患者术后细胞免疫抑制状态。

Effect of Early Perioperative Enteral Nutrition Support with Rhubarb and Sijunzi Decoction on Immune Function in Malnourished Surgical Patients with Gastric Cancer

Objective To observe the effect of early perioperative enteral nutrition support with rhubarb and Sijunzi decoction on immune function in malnourished surgical patients with gastric cancer.Methods Totally 40 malnourished patients with gastric cancer who had undergone surgical treatment were randomly divided into the control group(n=20,receiving a standard enteral diet)and the experimental group(n=20,receiving rhubarb,Sijunzi decoction,and standard enteral diet).Patients in both groups were given isocaloric and isonitrogenous enteral diets.The enteral diet was given 36 hours after surgery,and continued for 10 days in both two groups.Patients in the experimental group were fed with rhubarb at 1st day preoperative,and 18,36 hours postoperative,respectively.Sijunzi decoction was given 36 hours after surgery,and continued for 10 days.The immune indicators such as lymphocyte subsets(CD3,CD4,CD8,CD4/CD8)and serum immunoglobulins(IgA,IgG,and IgM)levels were measured before operation,and on the 1st and 10th postoperative day.Results The immunological variables remarkably changed after surgery in both groups.CD3,CD4,CD4/CD8,and IgG levelsin the experimental group were significantly higher than in the control group on the 10th postoperative day(P<0.05).Conclusion Compared with the standard enternal nutrition,perioperative administration of rhubarb and early post-operative Sijunzi decoction in patients with gastric cancer can ameliorate the host defense and improve the immunosupression status.