本文選題：多種油脂肪乳 + 胃腸道腫瘤��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的胃腸道腫瘤術(shù)后的老年患者,由于其機(jī)體處于嚴(yán)重應(yīng)激狀態(tài),因此會(huì)造成不同程度的炎癥反應(yīng)及免疫紊亂。此時(shí),若能合理應(yīng)用以腸外營(yíng)養(yǎng)為主的術(shù)后支持治療,則對(duì)患者術(shù)后整體機(jī)能的改善和術(shù)后良好的恢復(fù)具有重要意義。由于脂肪乳是腸外營(yíng)養(yǎng)中的重要組成部分,因此對(duì)脂肪乳的選擇就顯得至關(guān)重要。本文旨在探討多種油脂肪乳制劑(SMOFlipid-soybean oil,medium chain triglyceride,olive oil,fish oil)對(duì)老年胃腸道腫瘤患者術(shù)后免疫功能、炎癥反應(yīng)及營(yíng)養(yǎng)狀態(tài)的影響。方法將55例胃腸道腫瘤切除術(shù)后且NRS2002營(yíng)養(yǎng)風(fēng)險(xiǎn)評(píng)分超過3分需要腸外營(yíng)養(yǎng)支持至少4d以上的老年患者,按隨機(jī)對(duì)照的原則分為研究組27例和對(duì)照組組28例。術(shù)后第一天給予以葡萄糖為主要能源的腸外營(yíng)養(yǎng),并按所需基本能量的一半,進(jìn)行補(bǔ)充葡萄糖。由術(shù)后第二天起開始連續(xù)5d給予患者等氮0.2g/(kg·d)、等熱量104.6k J/(kg·d)以葡萄糖和脂肪乳為主要能源的腸外營(yíng)養(yǎng)支持,其中對(duì)照組脂肪乳采用20%中長(zhǎng)鏈混合脂肪乳1.2g/(kg·d)(力能?/Lipovenoes MCT);研究組脂肪乳采用多種油脂肪乳1.2g/(kg·d)(合文?/SMOFlipid?)。分別在術(shù)前、術(shù)后第1、6天清晨,抽取兩組患者的空腹外周靜脈血標(biāo)本。以檢測(cè)患者的炎癥指標(biāo):白細(xì)胞(WBC)、C反應(yīng)蛋白(CRP);營(yíng)養(yǎng)指標(biāo):總蛋白(TP)、白蛋白(ALB);肝腎功:谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)、肌酐(Cr)、尿素氮(BUN)及免疫指標(biāo):淋巴細(xì)胞總數(shù)(TLC)、淋巴細(xì)胞亞群(CD3+、CD4+、CD8+、CD19+)、免疫球蛋白(Ig A、Ig G、Ig M、Ig E)。將兩組試驗(yàn)所得數(shù)據(jù)運(yùn)用SPSS 19.0統(tǒng)計(jì)學(xué)軟件進(jìn)行重復(fù)測(cè)量方差分析。結(jié)果對(duì)兩組患者手術(shù)前后的各項(xiàng)免疫指標(biāo)、炎癥指標(biāo)及營(yíng)養(yǎng)指標(biāo)進(jìn)行檢測(cè)后,得出如下結(jié)果,兩組患者的免疫指標(biāo):CD3+、CD4+、CD8+、CD19+、Ig A、Ig M、Ig G、TLC;營(yíng)養(yǎng)指標(biāo)及肝腎功:TP、ALB、ALT、AST、BUN、Cr;炎性指標(biāo):WBC、CRP在手術(shù)前后不同時(shí)間之間有顯著差異(p0.05);兩組患者的CD19+、Ig G、TLC、TP在時(shí)間與分組之間存在交互效應(yīng)(p0.05);從各時(shí)間點(diǎn)看,兩組患者分別在術(shù)前及術(shù)后第1天各項(xiàng)指標(biāo)無(wú)顯著性差異,在術(shù)后第6天,研究組患者的免疫功能及炎癥反應(yīng)明顯改善,其CD3+、CD4+、Ig G、Ig A、TP水平均顯著高于對(duì)照組(p0.05),且CRP、WBC明顯低于對(duì)照組(p0.05)。結(jié)論對(duì)上述試驗(yàn)結(jié)果進(jìn)行討論分析可得出以下結(jié)論,應(yīng)用以腸外營(yíng)養(yǎng)為主的術(shù)后支持治療,對(duì)胃腸道腫瘤患者術(shù)后免疫功能恢復(fù)、炎癥狀態(tài)改善及保護(hù)肝腎功能是有益的;此外,研究組患者術(shù)后機(jī)體功能的恢復(fù)較對(duì)照組更為顯著,因此,將SMOFlipid用于老年胃腸道腫瘤患者術(shù)后的營(yíng)養(yǎng)支持治療,更有利于抑制由手術(shù)創(chuàng)傷所造成的過度炎癥反應(yīng),并能同時(shí)改善機(jī)體應(yīng)激狀態(tài)下的免疫抑制,提高機(jī)體免疫功能,對(duì)促進(jìn)患者術(shù)后恢復(fù)具有重要意義。
[Abstract]:Objective the elderly patients with gastrointestinal neoplasms after operation are in severe stress state, which may cause inflammatory reaction and immune disorder in varying degrees. At this time, if the postoperative support therapy with parenteral nutrition is used reasonably, it is of great significance to improve the overall function of the patients after operation and to recover well after the operation. Fat milk is an important part of parenteral nutrition, so it is very important to choose fat milk. The purpose of this paper is to investigate the effects of oil chain triglyceride-olive oilfish (SMOFlipid-soybean bean) on postoperative immune function, inflammatory response and nutritional status in elderly patients with gastrointestinal cancer. Methods 55 elderly patients with NRS2002 nutritional risk of more than 3 days after gastrointestinal tumor resection were divided into study group (n = 27) and control group (n = 28) according to the principle of randomized control. On the first day after surgery, glucose was given parenteral nutrition with glucose as the main energy source, and glucose was supplemented with half of the basic energy required. From the second day after operation, the patients were given iso-nitrogen 0.2g/(kg dU and equal calorie 104.6k J/(kg d for 5 consecutive days. The patients received parenteral nutrition with glucose and fat milk as the main energy sources. The control group was treated with 20% medium and long chain mixed fat emulsion 1.2g/(kg dct, and the study group with multiple oil fat emulsions, 1.2g/(kg dai (/ SMOFlipididae), and the control group (n = 10) with different types of fat emulsion, the control group (n = 10) and the control group (n = 20). Fasting peripheral venous blood samples were collected from two groups of patients before and 6 days after operation. In order to detect the inflammatory indexes of the patients: WBCC-reactive protein (CRPU); nutritional index: total protein TPN, Albumin (ALBN); liver and kidney function: alanine aminotransferase (alt), aspartate aminotransferase (ASTT), creatinine (Cr), urea nitrogen bun (BUNA) and immune index: total lymphocyte count (TLCN), lymphocytic count (TLCN), liver and kidney function: alanine aminotransferase (alt). CD3, CD 4, CD 8, CD 19, immunoglobulin I g, G G, Ig MU Ig E. The data of the two groups were analyzed by SPSS 19.0 statistical software. Results after testing the immune, inflammatory and nutritional indexes of the two groups of patients before and after operation, the following results were obtained. The immunological indexes of the two groups were CD3: CD3, CD4, CD8, CD19, Ig, Ig, Ig, TLCc, nutrition, liver and kidney function, and liver and kidney function. The inflammatory index was significantly different between the two groups before and after operation (p 0.05). There was an interaction effect between the time and the grouping of CD19 Ig TLCT in the two groups. From the point of view of each time, On the 6th day after operation, the immune function and inflammatory reaction of the patients in the study group were significantly improved, and there was no significant difference between the two groups before and on the first day after operation. The levels of CD3 CD 4, G G, G G, TP in the control group were significantly higher than those in the control group (P 0. 05), and the levels of CD3 in the control group were significantly lower than those in the control group (P 0. 05). Conclusion the following conclusions can be drawn from the discussion and analysis of the above results: the application of postoperative support therapy with parenteral nutrition is beneficial to the recovery of postoperative immune function, the improvement of inflammatory state and the protection of liver and kidney function in patients with gastrointestinal cancer. In addition, the recovery of body function in the study group was more significant than that in the control group. Therefore, the use of SMOFlipid in postoperative nutritional support therapy for elderly patients with gastrointestinal cancer was more beneficial to the suppression of the excessive inflammatory response caused by surgical trauma. It can also improve the immune suppression and immune function of the patients under stress. It is of great significance to promote the recovery of patients after operation.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 Massimiliano Rizzi;Silvia Mazzuoli;Nunzia Regano;Rosa Inguaggiato;Margherita Bianco;Gioacchino Leandro;Elisabetta Bugianesi;Donatella Noè;Nicoletta Orzes;Paolo Pallini;Maria Letizia Petroni;Gianni Testino;Francesco William Guglielmi;;Undernutrition, risk of malnutrition and obesity in gastroenterological patients: A multicenter study[J];World Journal of Gastrointestinal Oncology;2016年07期

2 林海冠;李寧;王新穎;朱維銘;姜軍;黎介壽;;SMOF脂肪乳劑對(duì)腹部中等手術(shù)后病人脂肪酸和炎性介質(zhì)的影響[J];腸外與腸內(nèi)營(yíng)養(yǎng);2010年04期

3 李秋榮;譚力;王暢;馬健;許國(guó)旺;黎介壽;;二十碳五烯酸改變JurkatT細(xì)胞膜脂肪微區(qū)域脂肪環(huán)境的研究[J];營(yíng)養(yǎng)學(xué)報(bào);2006年02期

4 汪灝;李秋榮;郝群;李幼生;李寧;黎介壽;;ω-3多不飽和脂肪酸對(duì)樹突狀細(xì)胞表型和功能的抑制作用[J];中華實(shí)驗(yàn)外科雜志;2005年12期

5 汪灝,黎介壽;ω-3多不飽和脂肪酸對(duì)免疫細(xì)胞功能的影響[J];腸外與腸內(nèi)營(yíng)養(yǎng);2004年05期

相關(guān)碩士學(xué)位論文 前1條

1 趙林;NRS2002在胃腸道惡性腫瘤患者術(shù)前營(yíng)養(yǎng)篩查中的應(yīng)用[D];青島大學(xué);2011年

，

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