CAJ | 학술논문

目的：观察联合应用早期肠内免疫营养与肠外营养对进展期胃癌患者术后营养状况和免疫功能的影响。方法筛选75例进展期胃癌患者，分为联合早期肠内免疫营养与肠外营养组（IEPN，n＝25）、联合早期普通肠内营养与肠外营养组（EPN，n＝25）、全肠外营养组（PN，n＝25）。 IEPN组患者于术后第2天起给予免疫肠内营养（瑞能，400 mL）和肠外营养（卡文，1440 mL）至第8天，EPN组患者给予肠内营养（瑞素，500 mL）和肠外营养（卡文，1440 mL），PN组患者给予肠外营养（卡文，1920 mL）。所有患者于术前和术后第8天分别检测营养指标（ ALB、PA、TP）、免疫指标（ CD3、CD4、CD8、IgA、IgM、IgG）和炎症指标（ C3、C4、CRP），并观察记录术后肠道功能恢复时间及吻合口瘘的发生率。结果术后第8天，3组ALB、PA、TP的差异无统计学意义（P＞0．05）；3组IgM的差异无统计学意义（P＞0．05），IEPN组IgA、CD3显著高于EPN组和PN组（P＜0．05），IEPN组患者CD4／CD8显著高于EPN组和PN组（P＜0．05），IgG、CD4显著高于PN组（P＜0．05），CD8显著低于EPN组和PN组（P＜0．05）；3组C4的差异无统计学意义（P＞0．05）；IEPN组C3显著高于PN组（P＜0．05），CRP显著低于PN组（P＜0．05）；IEPN组术后肠道功能恢复时间显著短于PN组（P＜0．05），3组均无吻合口瘘的发生。结论进展期胃癌患者术后联合应用早期肠内免疫营养与肠外营养能维持营养状态，可恢复免疫功能，降低全身炎症反应，促进患者术后肠道功能的恢复。
목적：관찰연합응용조기장내면역영양여장외영양대진전기위암환자술후영양상황화면역공능적영향。방법사선75례진전기위암환자，분위연합조기장내면역영양여장외영양조（IEPN，n＝25）、연합조기보통장내영양여장외영양조（EPN，n＝25）、전장외영양조（PN，n＝25）。 IEPN조환자우술후제2천기급여면역장내영양（서능，400 mL）화장외영양（잡문，1440 mL）지제8천，EPN조환자급여장내영양（서소，500 mL）화장외영양（잡문，1440 mL），PN조환자급여장외영양（잡문，1920 mL）。소유환자우술전화술후제8천분별검측영양지표（ ALB、PA、TP）、면역지표（ CD3、CD4、CD8、IgA、IgM、IgG）화염증지표（ C3、C4、CRP），병관찰기록술후장도공능회복시간급문합구루적발생솔。결과술후제8천，3조ALB、PA、TP적차이무통계학의의（P＞0．05）；3조IgM적차이무통계학의의（P＞0．05），IEPN조IgA、CD3현저고우EPN조화PN조（P＜0．05），IEPN조환자CD4／CD8현저고우EPN조화PN조（P＜0．05），IgG、CD4현저고우PN조（P＜0．05），CD8현저저우EPN조화PN조（P＜0．05）；3조C4적차이무통계학의의（P＞0．05）；IEPN조C3현저고우PN조（P＜0．05），CRP현저저우PN조（P＜0．05）；IEPN조술후장도공능회복시간현저단우PN조（P＜0．05），3조균무문합구루적발생。결론진전기위암환자술후연합응용조기장내면역영양여장외영양능유지영양상태，가회복면역공능，강저전신염증반응，촉진환자술후장도공능적회복。
Objective To observe the effect of postoperative early enteral immunonutrition combined parenteral nutrition on nu?tritional status and immune function in advanced gastric cancer patients. Methods Seventy-five advanced gastric cancer patients were selected and randomly divided into immune-enhancing enteral combined parenteral nutrition group (IEPN,n=25),enteral united par?enteral nutrition group (EPN,n=25) and parenteral nutrition group (PN,n=25). Patients of IEPN were given the immune-enhancing enteral nutrient (TPF-T,400 mL) and parenteral nutrition (Kabiven TM PI,1 440 mL) from the postoperative second day to the 8th day. Patients of EPN were given the enteral nutrient ( TP,500 mL) and parenteral nutrition ( Kabiven TM PI,1 440 mL) . Patients of PN were given parenteral nutrition (KabivenTM PI,1 920 mL). The levels of nutrition status (ALB,PA,TP),immune function (CD3,CD4, CD8,IgA,IgM,IgG),and stress status (C3,C4,CRP) were detected before operation and on postoperative 8th day. The anastomotic fis?tula and bowel function were observed. Results On the 8th day after operation,there was no statistic difference between each group on the serum levels of ALB,PA,TP (P>0. 05);there was no statistic difference between each group on the serum levels of IgM (P>0. 05);the serum levels of IgA and CD3 in IEPN group were significantly higher than those in EPN group and PN group(P<0. 05);the ratio of CD4/CD8 in IEPN group were significantly higher than that in EPN group and PN group (P<0. 05);the serum levels of IgG and CD4 in IEPN group were significantly higher than those in PN group (P<0. 05);the serum levels of CD8 in IEPN group were signifi?cantly lower than that in EPN group and PN group (P<0. 05);there was no statistic difference between each group on the serum levels of C4 (P>0. 05);the serum levels of C3 in IEPN group were significantly higher than those in PN group(P<0. 05);the serum levels of CRP in IEPN group were significantly lower than that in PN group (P<0. 05);the recovery time of postoperative bowel function in IEPN group was significantly shorter than PN group(P<0. 05);There was no anastomotic fistula in each group. Conclusion The application of postoperative early IEPN can maintain normal nutrition status,enhance immune function,lower systemic inflammatory reaction and ac?celerate the restoration of bowel function in patients with advanced gastric cancer.