本文選題：腸黏膜屏障　切入點：胃癌　出處：《山西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過臨床對比術(shù)后不同時間給予胃癌病人腸內(nèi)營養(yǎng),觀察分析腸黏膜屏障的檢測指標,探討早期腸內(nèi)營養(yǎng)對胃癌病人術(shù)后腸黏膜屏障功能的影響。方法:將山西醫(yī)科大學第一附屬醫(yī)院胃腸外科2015年6月至2016年10月收住院確診為胃癌并行胃癌根治術(shù)的60例病人按隨機數(shù)字表法分為觀察組(早期營養(yǎng)組,n=30)和對照組(非早期營養(yǎng)組,n=30)。早期營養(yǎng)組術(shù)后6h后即給予腸內(nèi)營養(yǎng),非早期營養(yǎng)組術(shù)后48h后給予腸內(nèi)營養(yǎng)。分別檢測病人術(shù)前1d、術(shù)后1d、4d和7d外周靜脈血中反映腸黏膜屏障功能的指標:血漿內(nèi)毒素(ET)、二胺氧化酶(DAO)、D-乳酸(D-Lac)水平,并記錄術(shù)后出現(xiàn)切口感染、肺部感染、尿路感染、腹腔膿腫等感染并發(fā)癥的發(fā)生例數(shù)。結(jié)果:早期營養(yǎng)組、非早期營養(yǎng)組兩組術(shù)前的各項檢測指標均無明顯差異(P0.05)。術(shù)后1d兩組的血漿ET、DAO、D-lac比術(shù)前明顯升高,與術(shù)前1d相比均存在明顯差異(P0.05);術(shù)后4d、7d兩組的指標均有不同程度的下降,總體水平高于術(shù)前,差異具有統(tǒng)計學意義(P0.05);兩組術(shù)后1d的各項指標相比無統(tǒng)計學意義(P0.05),術(shù)后4d、7d的各項指標早期營養(yǎng)組均比非早期營養(yǎng)組低,差異具有統(tǒng)計學意義(P0.05);術(shù)后早期營養(yǎng)組的病人出現(xiàn)的感染并發(fā)癥例數(shù)比非早期營養(yǎng)組的少,差異有統(tǒng)計學意義(P0.05)。結(jié)論:胃癌病人術(shù)后腸黏膜屏障功能的指標(血漿DAO、D-Lac、ET)均明顯升高,說明手術(shù)后早期病人的腸黏膜受到損害;胃癌術(shù)后給予早期腸內(nèi)營養(yǎng),病人均可耐受,早期營養(yǎng)組能夠明顯改善腸黏膜屏障功能;早期營養(yǎng)組比非早期營養(yǎng)組出現(xiàn)的感染并發(fā)癥少,維持腸黏膜的完整性,改善預后。
[Abstract]:Objective: to observe and analyze the detection index of intestinal mucosal barrier by clinical comparison of enteral nutrition in patients with gastric cancer at different time after operation. To investigate the effect of early enteral nutrition on intestinal mucosal barrier function in patients with gastric cancer after operation. Methods: from June 2015 to October 2016, gastrointestinal surgery in the first affiliated Hospital of Shanxi Medical University was admitted to hospital and diagnosed as gastric cancer with radical gastrectomy. Sixty patients were randomly divided into observation group (early nutrition group, n = 30) and control group (control group, n = 30). Early nutrition group was given enteral nutrition 6 hours after operation. In the non-early nutrition group, enteral nutrition was given 48 hours after operation. The levels of plasma endotoxin and D-lactamide were measured in peripheral venous blood of the patients 1 day before operation, 1 day after operation and 7 days after operation. Postoperative complications such as incision infection, pulmonary infection, urinary tract infection and abdominal abscess were recorded. There was no significant difference between the two groups in each index before operation (P 0.05). The plasma ETDAO D-lac in the two groups was significantly higher than that before operation on the 1st day after operation, and there was a significant difference between the two groups on the 1st day after operation (P 0.05), and on the 4th day after operation, the indexes of the two groups were decreased in varying degrees. The total level was higher than that before operation, the difference was statistically significant (P 0.05), the indexes of the two groups on the 1st day after operation had no statistical significance (P 0.05), and the indexes of the early nutrition group on the 4th day after operation were lower than those of the non-early nutrition group. The difference was statistically significant (P 0.05). The number of infection complications in the early nutrition group was less than that in the non-early nutrition group. Conclusion: the indexes of intestinal mucosal barrier function (plasma DAOOD-Lactein et) in patients with gastric cancer increased significantly after operation, indicating that the intestinal mucosa was damaged in the early stage after operation, and that the patients could tolerate early enteral nutrition after gastric cancer operation. The early nutrition group can obviously improve the intestinal mucosal barrier function, and the early nutrition group has fewer infection complications than the non-early nutrition group, which can maintain the integrity of intestinal mucosa and improve the prognosis.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.2

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