CAJ | 학술논문

目的探讨低热量肠外营养在老年胃癌患者术后的应用. 方法 59例老年胃癌患者术后随机分为29例低热量肠外营养组(低热量组)和30例常规肠外营养组(常规组),术后第2天起低热量组给予84 kJ·kg-1·d -1的肠外营养支持,常规组给予126 kJ·kg- 1·d-1的肠外营养支持,共6 d.观察两组患者营养支持期间的并发症、血清蛋白、免疫功能、炎症反应、血糖、肝功能及胃肠道功能恢复时间. 结果低热量组和常规组患者术后并发症发生率分别为37.9％ [11/29)和43.3％(13/30),以肺部感染为主(P＞0.05)；术后3d及6d血清白蛋白、总蛋白及前白蛋白水平常规组与低热量组比较差异无统计学意义(P＞0.05)；术后两组外周血淋巴细胞总数及T淋巴细胞亚群CD3+、CD4+、CD4+/CD8-比值均降低,CD8-值升高,两组差异无统计学意义(P＞0.0 5)；两组C反应蛋白术后3d比术前明显升高,术后6d比术后3d降低(P＞0.05)；两组血糖术后3d、6d逐渐降低(P＞0.05)；术后肝功能指标均升高,术后3d时两组比较差异无统计学意义(P＞0.05),术后6d时常规组仍持续升高,两组比较差异有统计学意义(P＜0.05)；低热量组患者术后排气、排便时间与常规组比较,差异无统计学意义(P＞0.05). 结论老年胃癌患者术后低热量肠外营养支持是一种安全有效的营养支持方法.
목적 탐토저열량장외영양재노년위암환자술후적응용. 방법 59례노년위암환자술후수궤분위29례저열량장외영양조(저열량조)화30례상규장외영양조(상규조),술후제2천기저열량조급여84 kJ·kg-1·d -1적장외영양지지,상규조급여126 kJ·kg- 1·d-1적장외영양지지,공6 d.관찰량조환자영양지지기간적병발증、혈청단백、면역공능、염증반응、혈당、간공능급위장도공능회복시간. 결과 저열량조화상규조환자술후병발증발생솔분별위37.9％ [11/29)화43.3％(13/30),이폐부감염위주(P＞0.05)；술후3d급6d혈청백단백、총단백급전백단백수평상규조여저열량조비교차이무통계학의의(P＞0.05)；술후량조외주혈림파세포총수급T림파세포아군CD3+、CD4+、CD4+/CD8-비치균강저,CD8-치승고,량조차이무통계학의의(P＞0.0 5)；량조C반응단백술후3d비술전명현승고,술후6d비술후3d강저(P＞0.05)；량조혈당술후3d、6d축점강저(P＞0.05)；술후간공능지표균승고,술후3d시량조비교차이무통계학의의(P＞0.05),술후6d시상규조잉지속승고,량조비교차이유통계학의의(P＜0.05)；저열량조환자술후배기、배편시간여상규조비교,차이무통계학의의(P＞0.05). 결론 노년위암환자술후저열량장외영양지지시일충안전유효적영양지지방법.
Objective To investigate the application of hypocaloric parenteral nutrition in postoperarive elderly patients with gastric cancer. Methods 59 elderly patients aged 60- 79 years with gastric cancer after operation were randomly assigned to receive 84 kJ · kg -1.d -1 hypocaloric parenteral nutrition (29 cases) and 126 kJ · kg-1 · d -1 standard-calorie parenteral nutrition (30cases),totally 6 d from postoperative 2 d. Complications, serum proteins, immune function,inflammation,blood glucose, liver function and recovery time of gastrointestinal function were observed during nutritional support. Results The postoperative complication rate were 37.9％(11/29) in hypocalorie group and 43.3 ％ (13/30) in standard calorie group ( P＞0.05),mainly pulmonary infection.There were no ditferences in levels of serum albumin,total protein and prealbumin between two groups at postoperative 3 d and 6 d (P＞0.05).Peripheral blood lymphocytes and T lymphocyte subsets CD3+,CD4+,CD4+/CD8- ratio were decreased after sugery,but CD8 1 values increased in two groups (P＞0.05).C reactive protein was increased significantly at postoperative 3 d compared with preoperation,and decreased at 6d than 3 d (P＞0.05).Blood glucose was decreased gradually at 3 and 6 d (P＞0.05).Postoperative liver function paraneters were elevated,no difference was found at 3 d (P＞0.05),and continued to rise at 6 d in standard calorie group than in hypocalorie group (P＜0.05). There was no difference in times of aerofluxus and cacation after operation between hypocalorie and standard calorie groups (P＞0.05). Conclusions Hypocaloric parenteral nutrition is a safe and effective method for nutrition support in postoperative elderly patients with gastric cancer.