中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
12期
1312-1316
,共5页
胃癌%糖预处理%序贯营养%胰岛素抵抗
胃癌%糖預處理%序貫營養%胰島素牴抗
위암%당예처리%서관영양%이도소저항
Stomach neoplasm%Preoperative carbohydrate loading%Sequential enteral nutrition%Insulin resistance
目的 探讨糖预处理联合序贯营养对胃癌患者术后恢复的影响.方法 将择期手术的98例胃癌患者应用随机数字表分为3组:术前常规禁食+术后序贯营养组(A组)33例,术前糖预处理+术后肠外营养组(B组)33例,术前糖预处理+术后序贯营养组(C组)32例.分析3组患者术前1d和术后第1、4、8天的胰岛素敏感指数(IS),术前1d和术后第4、8天的血清前白蛋白(PA)、转铁蛋白(TRF)、IgA、IgG、IgM,以及患者术后肛门排气时间、并发症发生情况及术后住院时间.结果 C组患者术后第4、8天IS(35.8±3.2、36.1±3.5)高于其他两组(A组:30.7 ±3.3、33.5±2.9,B组:33.7±3.1、34.0±2.2),差异均有统计学意义(F值分别为20.88、7.28,P均＜0.05).术后第4天B、C组PA高于A组[A组:(176.0±14.1) mg/L,B组:(191.0±11.6) mg/L,C组:(193.0±12.7) mg/L],差异有统计学意义(F=17.15,P＜0.01);术后第8天C组PA、TRF[(221.3±30.8)mg/L、(1.86±0.37) g/L]高于A、B组[A组:(198.0±30.6)mg/L、(1.60 ±0.33) g/L,B组:(202.0±28.6) mg/L、(1.61±0.34)g/L],差异均有统计学意义(F值分别为5.42、5.83,P均＜0.01);术后第8天C组IgA、IgG和IgM[(2.74±0.69)、(14.55±2.57)、(1.08±0.33) g/L]高于A、B组[A组:(2.30±0.54)、(12.71±2.94)、(0.86±0.31) g/L,B组:(2.29±0.50)、(12.06±3.33)、(0.89 ±0.27) g/L],差异均有统计学意义(F值分别为6.12、6.13、4.94,P均＜0.01).结论 术前糖预处理和术后序贯营养支持对胃癌患者术后恢复有良好作用,能降低其术后胰岛素抵抗,改善营养状况,促进机体免疫功能和肠道功能的恢复,减少术后并发症的发生.
目的 探討糖預處理聯閤序貫營養對胃癌患者術後恢複的影響.方法 將擇期手術的98例胃癌患者應用隨機數字錶分為3組:術前常規禁食+術後序貫營養組(A組)33例,術前糖預處理+術後腸外營養組(B組)33例,術前糖預處理+術後序貫營養組(C組)32例.分析3組患者術前1d和術後第1、4、8天的胰島素敏感指數(IS),術前1d和術後第4、8天的血清前白蛋白(PA)、轉鐵蛋白(TRF)、IgA、IgG、IgM,以及患者術後肛門排氣時間、併髮癥髮生情況及術後住院時間.結果 C組患者術後第4、8天IS(35.8±3.2、36.1±3.5)高于其他兩組(A組:30.7 ±3.3、33.5±2.9,B組:33.7±3.1、34.0±2.2),差異均有統計學意義(F值分彆為20.88、7.28,P均＜0.05).術後第4天B、C組PA高于A組[A組:(176.0±14.1) mg/L,B組:(191.0±11.6) mg/L,C組:(193.0±12.7) mg/L],差異有統計學意義(F=17.15,P＜0.01);術後第8天C組PA、TRF[(221.3±30.8)mg/L、(1.86±0.37) g/L]高于A、B組[A組:(198.0±30.6)mg/L、(1.60 ±0.33) g/L,B組:(202.0±28.6) mg/L、(1.61±0.34)g/L],差異均有統計學意義(F值分彆為5.42、5.83,P均＜0.01);術後第8天C組IgA、IgG和IgM[(2.74±0.69)、(14.55±2.57)、(1.08±0.33) g/L]高于A、B組[A組:(2.30±0.54)、(12.71±2.94)、(0.86±0.31) g/L,B組:(2.29±0.50)、(12.06±3.33)、(0.89 ±0.27) g/L],差異均有統計學意義(F值分彆為6.12、6.13、4.94,P均＜0.01).結論 術前糖預處理和術後序貫營養支持對胃癌患者術後恢複有良好作用,能降低其術後胰島素牴抗,改善營養狀況,促進機體免疫功能和腸道功能的恢複,減少術後併髮癥的髮生.
목적 탐토당예처리연합서관영양대위암환자술후회복적영향.방법 장택기수술적98례위암환자응용수궤수자표분위3조:술전상규금식+술후서관영양조(A조)33례,술전당예처리+술후장외영양조(B조)33례,술전당예처리+술후서관영양조(C조)32례.분석3조환자술전1d화술후제1、4、8천적이도소민감지수(IS),술전1d화술후제4、8천적혈청전백단백(PA)、전철단백(TRF)、IgA、IgG、IgM,이급환자술후항문배기시간、병발증발생정황급술후주원시간.결과 C조환자술후제4、8천IS(35.8±3.2、36.1±3.5)고우기타량조(A조:30.7 ±3.3、33.5±2.9,B조:33.7±3.1、34.0±2.2),차이균유통계학의의(F치분별위20.88、7.28,P균＜0.05).술후제4천B、C조PA고우A조[A조:(176.0±14.1) mg/L,B조:(191.0±11.6) mg/L,C조:(193.0±12.7) mg/L],차이유통계학의의(F=17.15,P＜0.01);술후제8천C조PA、TRF[(221.3±30.8)mg/L、(1.86±0.37) g/L]고우A、B조[A조:(198.0±30.6)mg/L、(1.60 ±0.33) g/L,B조:(202.0±28.6) mg/L、(1.61±0.34)g/L],차이균유통계학의의(F치분별위5.42、5.83,P균＜0.01);술후제8천C조IgA、IgG화IgM[(2.74±0.69)、(14.55±2.57)、(1.08±0.33) g/L]고우A、B조[A조:(2.30±0.54)、(12.71±2.94)、(0.86±0.31) g/L,B조:(2.29±0.50)、(12.06±3.33)、(0.89 ±0.27) g/L],차이균유통계학의의(F치분별위6.12、6.13、4.94,P균＜0.01).결론 술전당예처리화술후서관영양지지대위암환자술후회복유량호작용,능강저기술후이도소저항,개선영양상황,촉진궤체면역공능화장도공능적회복,감소술후병발증적발생.
Objective To explore the effect of combination application of preoperative carbohydrate loading and sequential enteral nutrition on the recovery of postoperative patients with stomach neoplasm.Methods Ninety-eight patients with stomach neoplasm were randomly divided into three groups.Those were Group A (preoperative fasting + sequential EN,n =33),group B (preoperative carbohydrate loading + postoperative TPN,n =33) and group C (preoperative carbohydrate loading + sequential EN,n =32).Insulin sensitivity (IS) ; Nutritional indicators including pre-albumin (PA) and transferrin (TRF) ; immunity parameters including IgG,IgM and IgA were measured in blood on the day before the operation,the 1st day,4th day and 8th day after the operation.Meanwhile,anal exhaust time after the operation,incidence of complications and postoperative hospitalizing time were also observed.Results The level of IS in group C at 4th day and 8th day after operation were 35.8 ± 3.2 and 36.1 ± 3.5,higher than those in A group and B group (A group:30.7 ±3.3,33.5 ±2.9;B group:33.7 ±3.1,34.0 ±2.2),and the differences were significant((F =20.88,7.28 ;P ＜0.05).At the 4th day after the operation,the levels of PA in group B and group C were (191 ± 11.6) mg/ and (193 ± 12.7) mg/L,significantly higher than those in group A ((176 ± 14.1) mg/L;F =17.15,P ＜ 0.01).At the 8th day after the operation,the levels of PA and TRF in group C were (221.3 ±30.81) mg/L and (86 ± 0.37) g/L,significantly higher than those in group A and group B (group A:(198.0 ± 30.6) mg/L,(1.60 ± ±0.33) g/L;group B:(202.0 ±28.6) mg/L,(1.61 ±0.34) g/L;F =5.42,5.83 ;P ＜0.01).At the 8th day after the operation,the levels of IgA,IgG and IgM in the group C were (2.74 ±0.69) g/L,(14.55 ±2.57) g/ L,(1.08 ± 0.33) g/L,significantly higher than that in group A and group B (group A:(2.30 ± 0.54) g/L,(12.71 ±2.94) g/L,(0.86 ±0.31) g/L;group B:(2.29 ±0.50) g/L,(12.06 ±3.33) g/L,(0.89 ±0.27)g/L;F =6.12,6.13,4.94;P ＜ 0.05).Conclusion The combination of preoperative carbohydrate loading and sequential enteral nutrition can reduce insulin resistance,improve postoperative nutritional status,improve the recovery of immune function and intestinal function,as well as reduce the incidence of postoperative complications.
