上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (7): 1000-.doi: 10.3969/j.issn.1674-8115.2011.07.029

• 论著（临床研究） • 上一篇    下一篇

免疫强化肠内与肠外营养对老年胃癌患者全胃切除术后营养和免疫功能的影响

刘 骅, 凌 伟, 曹 晖   

  1. 上海交通大学 医学院附属仁济医院普外科, 上海 200127
  • 出版日期:2011-07-28 发布日期:2011-07-27
  • 通讯作者: 曹 晖, 电子信箱: caohuishcn@hotmail.com。
  • 作者简介:刘 骅（1973—）, 男, 副主任医师, 博士；电子信箱: housman111@hotmail.com。

Effects of immune-enhanced enteral nutrition and parenteral nutrition on immune |and nutritional function in elderly patients with gastric cancer after total gastrectomy

LIU Hua, LING Wei, CAO Hui   

  1. Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-07-28 Published:2011-07-27

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摘要：

目的 探讨谷氨酰胺强化肠内营养支持对老年胃癌患者全胃切除术后营养及免疫功能的影响。方法 84例接受全胃切除术的进展期老年胃癌患者随机分为谷氨酰胺强化肠内营养组（Gln组，n=28）、常规肠内营养组（EN组，n=28）和肠外营养组（PN组，n=28），观察术后肛门排气恢复时间、术后并发症发生率和住院天数；分别于术前1 d和术后第2、10天，检测血清总蛋白、白蛋白、前白蛋白和转铁蛋白；术后第10天，测定外周血CD4+T细胞和CD8+T细胞百分比并计算CD4+T细胞与CD8 T+细胞的比值（CD4+/ CD8+），测定血清免疫球蛋白IgM和IgG。结果 Gln组和EN组术后平均术后肛门排气时间和住院时间均显著短于PN组（P<0.05）；三组患者术后并发症发生率比较差异无统计学意义（P>0.05）；术后第2天，三组患者血清总蛋白、白蛋白、前白蛋白和转铁蛋白的质量浓度均较术前明显降低（P<0.05）；术后第10天，Gln组和EN组血清总蛋白、白蛋白和前白蛋白的质量浓度明显高于PN组（P<0.05）；术后第10天，Gln组外周血CD4+T细胞和CD8+T细胞百分比、CD4+/CD8+及血清IgM和IgG的质量浓度均基本恢复至术前水平，且显著高于相同时点的EN组和PN组（P<0.05）。结论 对于接受全胃切除的老年胃癌患者，术后早期应用谷氨酰胺强化肠内营养是安全可行的，在恢复和改善营养及免疫功能的同时，可促进患者术后恢复，缩短住院时间。

关键词: 谷氨酰胺, 肠内营养, 全胃切除, 老年, 临床应用

Abstract:

Objective To evaluate the effects of immune-enhanced enteral nutritional support on the immune and nutritional function in elderly patients with gastric cancer after total gastrectomy. Methods Eighty-four elderly patients with gastric cancer undergoing total gastrectomy were randomly divided into glutamine-enhanced enteral nutrition  group (Gln group, n=28), conventional enteral nutrition group (EN group, n=28) and parenteral nutrition group (PN group, n=28). The time of anal exhaust after operation, incidences of postoperative complications and duration of hospitalization were observed. Serum total protein, albumin, proalbumin and transferrin were measured 1 d before operation, 2 d and 10 d after operation. Ten days after operation, the percentages of CD4+T cells and CD8+T cells in peripheral blood were measured, the ratio of CD4+T cells to CD8+T cells （CD4+/CD8+）was calculated, and the serum IgM and IgG were detected. Results The time of anal exhaust after operation and duration of hospitalization in Gln group and EN group were significantly shorter than those in PN group (P<0.05), while there was no significant difference in the incidences of postoperative complications among three groups (P>0.05). Two days after operation, the mass concentrations of serum total protein, albumin, proalbumin and transferrin were significantly lower than those before operation in three groups (P<0.05). Ten days after operation, the mass concentrations of serum total protein, albumin and proalbumin in Gln group and EN group were significantly higher than those in PN group (P<0.05). Ten days after operation, the percentages of CD4+T cells and CD8+T cells in peripheral blood, CD4+/CD8+ , and serum mass concentrations of IgM and IgG in Gln group recovered to those before operation, and were significantly higher than those in EN group and PN group at the same time point (P<0.05). Conclusion For elderly patients with gastric cancer undergoing total gastrectomy, glutamine-enhanced nutritional support early after operation is safe and feasible, which can improve nutritional and immune function, promote recovery and reduce duration of hospitalization.

Key words: glutamine, enteral nutrition, total gastrectomy, elderly, clinical application