营养方式对消化管肿瘤患者术后早期氧化应激反应和临床结局的影响

摘要

目的 比较消化管恶性肿瘤患者术后早期肠外营养( parenteral nutrition,PN)与PN联合肠内营养(enteral nutrition,EN)对患者术后氧化应激反应和临床结局的影响.方法 将择期进行消化管恶性肿瘤根治术的患者随机分为PN组(30例)和PN+ EN组(30例),记录患者一般资料,术前、术后1周的营养相关指标、氧化应激指标,并比较两组患者的临床结局.结果 两组患者术后1周BMI水平较术前均显著下降(P＜0.05)；ALB、PA较术前无显著性差异；PN组术后1周HGB、淋巴细胞数较术前显著下降(P＜0.05),而PN+ EN组HGB含量较术前无显著性差异,淋巴细胞数显著升高(P＜0.05)；两组患者术后1周SOD含量均显著升高(P＜0.05)；PN组GSH含量较术前显著下降(P＜0.05)；而PN+ EN组GSH含量较术前显著升高(P＜0.05)；PN组MDA含量较术前显著升高(P＜0.05),而PN+ EN组MDA含量较术前显著下降(P＜0.05)；PN+ EN组患者在肛门排气恢复时间、手术后住院时间和营养治疗费用均明显低于PN组(P＜0.05),并发症发生率低于PN组,但未见显著性差异(P＞0.05).结论 PN+ EN在提高机体抵抗术后氧化应激反应能力和改善临床结局方面优于PN,可作为消化管肿瘤患者术后首选的营养方式.%Objective To evaluate the effect of different postoperative nutritional support on oxidative stress and clinical outcomes for patients after gastrointestinal surgery. Methods Sixty patients undergoing gastrointestinal neoplasm radical surgery were randomly divided into two groups: parenteral nutrition ( PN) group and parenteral nutrition combined with enteral nutrition ( PN + EN ) group, 30 cases in each group. Basic conditions, nutrition status, oxidative stress indices and clinical outcomes were compared. Results BMI in both groups was significantly decreased one week after surgery (P<0.05). There was no significant difference in concentrations of ALB and PA between the two groups after operation. The concentration of HGB and lymphocytes in the PN group was significantly decreased one week after surgery ( P <0. 05) while the concentration of HGB in the PN + EN group was not significantly different but lymphocytes were significantly increased ( P <0.05 ). SOD activities were significantly increased in both groups one week after surgery (P<0.05). GSH activity in the PN group was significantly decreased (P<0.05) ; but was significantly increased in the PN + EN group (P <0.05). MDA content in the TPN group was significantly increased one week after surgery (P < 0.05), but decreased significantly in the PN + EN group (P<0.05). The recovery time of anal passing flatus, postoperative hospital stay and cost of nutrition treatment in the PN + EN group patients were well below those in the PN group ( P <0.05). The complication rate was decreased compared with the PN group, though not significantly (P>0. 05). Conclusions PN + EN improves the ability against the postoperative oxidative stress and clinical outcomes, so it can be the first choice for nutritional support in patients undergoing gastrointestinal surgery.