围手术期肠内营养支持对胃肠道恶性肿瘤患者的疗效评估

摘要

目的 探讨围手术期肠内营养对胃肠道恶性肿瘤患者的可行性及疗效.方法 选择100例胃肠道恶性肿瘤患者,随机分为两组:实验组50例(肠内营养)和对照组50例(肠外营养),在术前5 d、1 d和术后1 d、7d测量两组患者体重(B、W)、体重指数(BMI)、三头肌皮褶厚度(TSF)、上臂肌围(AMC),并抽取静脉血检测血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TF)、NK细胞、T淋巴细胞亚群(CD3、CD4、CD8)和血清免疫球蛋白(IgG、IgA、IgM)各指标.结果 术后第7天,两组患者BW、BMI、TSF、AMC与同组术前5 d比较均有所升高,但差异无统计学意义,两组间比较差异也无统计学意义;术后第7天,两组ALB、PA、TF都有所上升,其中实验组的PA和TF显著升高,两组间差异都有统计学意义;实验组的NK细胞、CD3、CD4、IgA、IgM都有显著的升高,但是CD8和IgG没有显著变化,对照组都没有显著变化;术前5 d两组间NK细胞、CD3、CD4、CD8、IgA、IgM、IgG都没有显著差异,但术后7 d除CD8外,两组间差异有统计学意义.结论 围手术期应用肠内营养能更好地改善患者营养状况和免疫功能,降低手术风险和减少术后并发症.%To evaluate the feasibility and curative effects ofperioperative enteral nutrition on the patients with gi neoplasm malignant. Methods The patients with gi neoplasm malignant (ri=t00) were randomly divided into two groups: experimental (enteral nutrition, n = 50) and control (Parenteral nutrition, n=50) groups, then bodyweight (BW), body mass index (BMI), triceps skinfold thickness (TSF), arm muscle circumference (AMC) and venous blood samples were collected to examine the albumin (ALB), Prealbumin (PA), transferrin (TF), NK cell,CD3, CD4, CD8, immunoglobulin IgG, IgA, IgM at the fifth and first day pre-operationally, and first and seventh day post-operatively. Results There were no significant differences between BW, BMI, TSF, AMC on pre-operationally and those on seventh day post-operatively in two groups, and no significant effect of group. There were significant increases in PA and TF, and significant group effect, but the ALB did not increase significanfiy. There were significant increases in NK cell, CD3, CD4, IgA and IgM of experimental group, whereas, the CD8 and IgG of experimental group and the NK cell, CD3, CD4, CD8, IgG, IgA, IgM of control group did not change significantly. the NK cell, CD3, CD4, IgG, IgA, IgM in the experimental group were significantly higher than those in control group on seventh day post-operatively. Conclusion The application of enteral nutrition in perioperative period can do better in preventing malnutritional status, enhancing the immunological function, decreasing surgical risk and postoperative complications.