CAJ | 학술논문

目的观察早期进食肠内营养制剂对结直肠癌患者临床结局和免疫功能的影响.方法 88例结直肠癌患者随机分为试验组(43例)和对照组(45例).试验组术后早期少量多次进水和肠内营养制剂,对照组采用传统治疗方案.比较2组患者术前和术后第1、3、7天IgA、IgG、IgM以及CD4+、CD4+/CD8+和C-反应蛋白(C-reactive protien,CRP)水平,记录术后住院天数、并发症及生活质量等指标.结果试验组术后发热时间[(54±6)h比(65 ±6)h,=8.688,P＜0.01]、排气时间[(58±8)h比(72 ±7)h,t=8.573,P＜0.01]、住院时间[(6.9±1.4)d比(8.5±1.9)d,t=4.277,P＜0.01]以及治疗费用[(41 868 ±3 168)元比(45 950±3 714)元,t=5.536,P＜0.01]明显少于对照组,差异有统计学意义,而2组术后并发症发生[18.6％ (8/43)比22.2％ (10/45),t=0.177,P＞0.05]相比差异无统计学意义;试验组出院时生活质量评分[(18.4±1.7)比(16.4±1.9),t=5.235,P＜0.01]明显高于对照组.术后第7天试验组CD4+、CD4 +/CD8+和IgM水平明显高于对照组(t=3.639,t =2.255,t=2.119,P＜0.05);术后第3天和第7天试验组IgA、IgG明显高于对照组(t=2.035,t =2.961,t=2.060,t =2.108,P＜0.05);术后第3天和第7天试验组CRP水平明显低于对照组(t =7.308,t=3.435,P＜0.05).结论术后早期进食肠内营养制剂能够改善结直肠癌患者免疫功能,降低应激反应、促进康复.
목적 관찰조기진식장내영양제제대결직장암환자림상결국화면역공능적영향.방법 88례결직장암환자수궤분위시험조(43례)화대조조(45례).시험조술후조기소량다차진수화장내영양제제,대조조채용전통치료방안.비교2조환자술전화술후제1、3、7천IgA、IgG、IgM이급CD4+、CD4+/CD8+화C-반응단백(C-reactive protien,CRP)수평,기록술후주원천수、병발증급생활질량등지표.결과 시험조술후발열시간[(54±6)h비(65 ±6)h,=8.688,P＜0.01]、배기시간[(58±8)h비(72 ±7)h,t=8.573,P＜0.01]、주원시간[(6.9±1.4)d비(8.5±1.9)d,t=4.277,P＜0.01]이급치료비용[(41 868 ±3 168)원비(45 950±3 714)원,t=5.536,P＜0.01]명현소우대조조,차이유통계학의의,이2조술후병발증발생[18.6％ (8/43)비22.2％ (10/45),t=0.177,P＞0.05]상비차이무통계학의의;시험조출원시생활질량평분[(18.4±1.7)비(16.4±1.9),t=5.235,P＜0.01]명현고우대조조.술후제7천시험조CD4+、CD4 +/CD8+화IgM수평명현고우대조조(t=3.639,t =2.255,t=2.119,P＜0.05);술후제3천화제7천시험조IgA、IgG명현고우대조조(t=2.035,t =2.961,t=2.060,t =2.108,P＜0.05);술후제3천화제7천시험조CRP수평명현저우대조조(t =7.308,t=3.435,P＜0.05).결론 술후조기진식장내영양제제능구개선결직장암환자면역공능,강저응격반응、촉진강복.
Objective To observe the effect of early enteral feeding on clinical outcomes and immune function in patients after colorectal cancer surgery.Methods 90 cases of colorectal cancer patients were randomly divided into early enteral feeding group (43 cases) and control group (45 cases).Patients in early feeding group were given small amount of water several times and enteral nutrition early after surgery,while patients in the control group were administrated according to conventional postoperative care protocol.Data were collected on serum IgA,IgG,IgM,CD4 +,CD4 +/CD8 + and CRP on the postoperative first,third and seventh days,postoperative length of stay,complications and quality of life.Results The postoperative fever time [(54 ±6) h vs.(65 ±6) h,t =8.688,P ＜0.01],time to flatus [(58 ±8) h vs.(72±7) h,t=8.573,P＜0.01],postoperative length of stay [(6.9±1.4) dvs.(8.5 ±1.9) d,t=4.277,P ＜ 0.01] and health care cost [(41 868 ± 3 168) RMB vs.(45 950 ± 3 714) RMB,t =5.536,P ＜ 0.01] were significantly in favour of early enteral feeding group than those in control group.Further,the score of quality of life at discharge were significantly higher in early enteral feeding group [(18.4 ± 1.7) vs.(16.4 ± 1.9),t =5.235,P ＜ 0.01],while the complication incidence showed no difference between the two groups [18.6％ (8/43) vs.22.2％ (10/45),t=0.177,P＞0.05].The CD4+,CD4+/CD8+ and IgM on the seventh postoperative day and the IgA and IgG on the third and seventh postoperative day were significantly better in early enteral feeding group while the CRP was significantly lower as compared to the control group (t =3.639,t =2.255,t =2.119,t =2.035,t =2.961,t =2.060,t =2.108,t =7.308,t =3.435,P ＜ 0.05).Conclusions Early oral enteral feeding after elective colorectal cancer surgery can improve patient's immune function,reduce the stress and accelerate rehabilitation.