CAJ | 학술논문

目的：对比观察消化道肿瘤术后早期肠内营养联合肠外营养支持治疗与全肠外营养支持治疗对患者营养、免疫功能及术后恢复的影响。方法：选取南京市高淳人民医院2012年1月—2013年12月行消化道恶性肿瘤手术的患者110例，以随机数字表法分为A、B 2组各55例。 A组患者给予早期肠内营养联合肠外营养支持治疗，B组患者给予全肠外营养支持治疗。于术前1 d和术后7d检测患者的营养指标（体质量、白蛋白水平、前白蛋白水平）和免疫指标（免疫球蛋白A、免疫球蛋白G、免疫球蛋白M水平），记录患者排气、排便时间及并发症发生情况，比较2种营养支持方法对患者营养和免疫功能的影响。结果：A组患者的排气时间、排便时间、住院时间、住院费用、营养费用及丙氨酸转氨酶、总胆红素、直接胆红素水平均明显低于B组，免疫球蛋白G、免疫球蛋白A水平均明显高于B组，差异均有统计学意义（P＜0.05）。2组患者吻合口瘘、肝损害情况的差异无统计学意义（P＞0.05）；A组患者腹胀、腹痛、腹泻发生率明显高于B组，差异有统计学意义（ P＜0.05）。结论：术后早期肠内营养联合肠外营养支持治疗可维护患者肠道功能，能更好地改善消化道肿瘤术后患者的营养及免疫功能，营养支持效果优于全肠外营养支持治疗。
목적：대비관찰소화도종류술후조기장내영양연합장외영양지지치료여전장외영양지지치료대환자영양、면역공능급술후회복적영향。방법：선취남경시고순인민의원2012년1월—2013년12월행소화도악성종류수술적환자110례，이수궤수자표법분위A、B 2조각55례。 A조환자급여조기장내영양연합장외영양지지치료，B조환자급여전장외영양지지치료。우술전1 d화술후7d검측환자적영양지표（체질량、백단백수평、전백단백수평）화면역지표（면역구단백A、면역구단백G、면역구단백M수평），기록환자배기、배편시간급병발증발생정황，비교2충영양지지방법대환자영양화면역공능적영향。결과：A조환자적배기시간、배편시간、주원시간、주원비용、영양비용급병안산전안매、총담홍소、직접담홍소수평균명현저우B조，면역구단백G、면역구단백A수평균명현고우B조，차이균유통계학의의（P＜0.05）。2조환자문합구루、간손해정황적차이무통계학의의（P＞0.05）；A조환자복창、복통、복사발생솔명현고우B조，차이유통계학의의（ P＜0.05）。결론：술후조기장내영양연합장외영양지지치료가유호환자장도공능，능경호지개선소화도종류술후환자적영양급면역공능，영양지지효과우우전장외영양지지치료。
OBJECTIVE:To probe into the effect of postoperative early enteral nutrition combined with parenteral nutrition ( EEN +PN) and total parenteral nutrition ( TPN) on the patients'nutrition, immune function and the postoperative recovery .METHODS: 110 postoperative patients with gastrointestinal cancer from Jan .2012 to Dec. 2013 in Nanjing Gaochun People's Hospital were divided in to group A and group B via the random number table , with 55 cases in each group .Group A were given EEN+PN, group B received TPN .Patients were checked for nutritional indexes (weight, albumin level, prealbumin level) and immune indexes (IgA, IgG, IgM) on the preoperative 1st day and postoperative 7 th day; the time of passing gas , defecation time and occurrence of complications were recorded;effect of two kinds of nutrition support methods on the patients'nutrition and immune function were compared . RESULTS: The time of passing gas , defecation time , hospitalization time , hospitalization costs , nutrition costs , alanine aminotransferase , total bilirubin and direct bilirubin level in group A were significantly lower than that in group B;IgG and IgA level in group A were significantly higher than that in group B , with statistically significant difference ( P<0.05 ) .There were no significant difference between two groups in anastomotic leakage and liver damage ( P>0.05 ) .The incidence of abdominal distension , abdominal pain and diarrhea in group A was higher than that in group B, with statistically significant difference ( P<0.05 ) .CONCLUSIONS: The supportive treatment of EEN +PN can maintain the patients'intestinal function , improve the nutrition and immune function of the postoperative patients , which also has a better supportive efficacy than the supportive treatment of TPN .