不同剂量强化精氨酸肠内营养对口腔头颈部恶性肿瘤患者营养状态及免疫功能的影响

摘要

目的：探讨不同剂量强化精氨酸肠内营养对口腔头颈部恶性肿瘤患者术后营养状态及免疫功能的影响。方法口腔头颈部恶性肿瘤患者80例按随机数字表法分为实验1组、实验2组，各40例。术后24 h内给予实验1组强化精氨酸（10 g／d），实验2组强化精氨酸[0．3 g／（kg· d）]的等氮、热量肠内营养支持。2组患者分别于术前1 d、术后10 d分别检测血清总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）及淋巴细胞比值（LY）等指标；观察两组患者术后腹胀、腹泻、恶心呕吐等不良反应。结果术前1 d两组血清TP、ALB、PA、LY水平比较，差异无统计学意义（P＞0．05）。术后10 d实验1组血清TP、ALB、PA及LY水平与术前1 d比较，差异无统计学意义（ P＞0．05）；术后10 d实验2组血清LY水平较术前1 d有所上升（P＜0．05），实验2组其他指标与术前1 d比较，差异无统计学意义（P＞0．05）。术后10 d实验2组血清LY水平明显高于实验1组（P＜0．05）。两组患者鼻饲营养后胃肠道不良反应发生率比较，差异无统计学意义（P＞0．05）。结论强化精氨酸0．3 g／（kg· d）较10 g／d剂量的肠内营养更有利于患者免疫功能恢复。%Objective To investigate the effects of different doses of enriched arginine enteral nutrition on postoperative nutritional status and immune function of patients who suffer from oral ,head and neck malignancies .Methods Eighty patients who suffered from oral,head and neck malignancies were randomly divided into experimental group 1 and experimental group 2,with 40 patients in each group.The patients in the experimental group 1 and experimental group 2 were fed with enriched arginine (10 g/day) and enriched arginine (0.3 g/[kg· d])enteral nutrition,respectively,within 24 hours after surgery.Serum indicators of patients including total protein (TP), albumin(ALB),prealbumin(PA),LY and others were detected one day before and 10 days after surgery in two groups .The gastrointestinal adverse reactions including abdominal distention ,diarrhea ,nausea and vomiting after surgery were observed in two groups .Results There were no statistical differences in the levels of serum TP ,ALB,PA and LY one day before surgery between two groups (P>0.05).The levels of serum TP,ALB,PA and LY 10 days after surgery showed no significant differences in contrast with those one day before surgery in the experiment group 1(P>0.05).In the experimental group 2,the level of serum LY increased(P<0.05) but other indexes showed no significant differences 10 days after surgery compared with the 1-day preoperative(P>0.05).The level of serum LY 10 days after surgery in the experimental group 2 was significantly higher than that in the experimental group 1(P<0.05).There was no significant difference in the incidence of gastrointestinal adverse reactions between two groups after being given enriched arginine by nasal feeding (P>0.05). Conclusion Enriched arginine of (0.3 g/[kg· d]) has better effect on patients′immune function recovery compared with enriched arginine of 10 g/day.