本文選題：早期免疫腸內(nèi)營(yíng)養(yǎng) + 全腸外營(yíng)養(yǎng)　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景由于胃腸道惡性腫瘤本身導(dǎo)致的高消耗,慢性失血及胃腸道功能紊亂等諸多因素,營(yíng)養(yǎng)不良及惡病質(zhì)在腫瘤患者中很常見。而營(yíng)養(yǎng)不良及惡病質(zhì)又是導(dǎo)致癌癥患者死亡的主要原因之一。手術(shù)治療是胃腸道惡性腫瘤早中期主要的治療方式,但手術(shù)引起的創(chuàng)傷、應(yīng)激等因素,又進(jìn)一步加重了患者營(yíng)養(yǎng)不良程度,已有研究已經(jīng)闡明了術(shù)后并發(fā)癥的發(fā)病率與腫瘤患者營(yíng)養(yǎng)不良發(fā)病率呈正相關(guān)關(guān)系。胃腸癌患者術(shù)后常伴有營(yíng)養(yǎng)不良和免疫功能抑制,免疫抑制可增加術(shù)后并發(fā)癥,減緩患者的康復(fù)和誘導(dǎo)腫瘤的復(fù)發(fā)、轉(zhuǎn)移與惡化。所以不難看出,胃腸道癌癥患者的臨床預(yù)后很大程度上受到營(yíng)養(yǎng)狀況的影響。因此,術(shù)后加強(qiáng)營(yíng)養(yǎng)支持以改善患者的免疫功能具有重要的臨床意義。目前術(shù)后營(yíng)養(yǎng)支持主要分為腸內(nèi)營(yíng)養(yǎng)與腸外營(yíng)養(yǎng),但在二者的選擇、開始時(shí)間以及成分等方面仍存在著疑問。目的本項(xiàng)目擬以即將行胃癌根治手術(shù)患者為研究對(duì)象,隨機(jī)分為早期免疫增強(qiáng)型腸內(nèi)營(yíng)養(yǎng)組(EEIN)與全腸外營(yíng)養(yǎng)(TPN)組,比較兩組患者術(shù)前與腸道營(yíng)養(yǎng)8天后營(yíng)養(yǎng)狀態(tài),術(shù)后并發(fā)癥,免疫功能,術(shù)后30天營(yíng)養(yǎng)狀態(tài),以及無進(jìn)展生存期,無長(zhǎng)期術(shù)后并發(fā)癥生存期的差別。比較出早期免疫增強(qiáng)型腸內(nèi)營(yíng)養(yǎng)與完全腸外營(yíng)養(yǎng)患者術(shù)后營(yíng)養(yǎng)免疫狀態(tài)、臨床預(yù)后及生活質(zhì)量等方面優(yōu)劣,對(duì)于術(shù)后患者營(yíng)養(yǎng)支持方式的選擇具有重要的指導(dǎo)意義,為免疫增強(qiáng)型腸內(nèi)營(yíng)養(yǎng)的臨床應(yīng)用和推廣提供依據(jù)。方法將符合入組條件的70例胃癌患者隨機(jī)分為早期免疫腸內(nèi)營(yíng)養(yǎng)組(EEIN組n=35)與全腸外營(yíng)養(yǎng)組(TPN組n=35)。在術(shù)前第1天、術(shù)后第8天抽取外周靜脈血,檢測(cè)免疫細(xì)胞比例及其表面標(biāo)志物表達(dá),血清中IL-2、IFN-g、TNF-a、IL-10的表達(dá)水平以及臨床相關(guān)指標(biāo)包括血紅蛋白、血清白蛋白、前白蛋白含量并觀察患者術(shù)后恢復(fù)情況,電話隨訪生存期。結(jié)果EEIN組患者術(shù)后8天多數(shù)免疫水平指標(biāo)顯著高于TPN組,且炎癥水平指標(biāo)顯著低于TPN組,且差異有顯著性統(tǒng)計(jì)學(xué)意義(P0.05)。EEIN組患者術(shù)后體重下降、術(shù)后首次排氣時(shí)間和住院天數(shù)明顯減少,術(shù)后第8天TP、ALB、PA、TG,術(shù)后30天BMI指數(shù)、ALB、PA以及TG水平顯著高于TPN組(P0.05),EEIN可顯著延長(zhǎng)無并發(fā)癥生存期及術(shù)后無進(jìn)展生存期。結(jié)論EEIN可激活胃癌患者免疫功能,改善術(shù)后營(yíng)養(yǎng)狀態(tài),有助于患者術(shù)后無進(jìn)展生存期的延長(zhǎng)和生活質(zhì)量的提高。
[Abstract]:Background malnutrition and cachexia are common in cancer patients due to many factors such as high consumption of gastrointestinal malignant tumors, chronic blood loss and gastrointestinal dysfunction. Malnutrition and cachexia are one of the leading causes of cancer deaths. Surgical treatment is the main treatment for gastrointestinal malignant tumors in the early and middle stages. However, the trauma and stress caused by the operation have further aggravated the degree of malnutrition in the patients. Studies have shown a positive correlation between the incidence of postoperative complications and the incidence of malnutrition in cancer patients. Postoperative gastrointestinal cancer patients are often accompanied by malnutrition and immunosuppression, immunosuppression can increase postoperative complications, slow down the recovery of patients and induce tumor recurrence, metastasis and deterioration. Therefore, it is not difficult to see that the prognosis of gastrointestinal cancer patients is largely affected by nutritional status. Therefore, it is of great clinical significance to strengthen nutritional support to improve the immune function of patients after operation. At present, postoperative nutritional support is mainly divided into enteral nutrition and parenteral nutrition, but there are still some questions about their choice, starting time and composition. Objective to divide the patients undergoing radical gastric cancer operation into two groups: early immune-enhanced enteral nutrition group (EEIN) and total parenteral nutrition (TPN) group. The nutritional status and postoperative complications were compared between the two groups before and after 8 days of enteral nutrition. The difference of immune function, nutritional status 30 days after operation, progression free survival and long term postoperative complications. The nutritional immunity status, clinical prognosis and quality of life of patients with early immune-enhanced enteral nutrition and complete parenteral nutrition were compared. To provide the basis for the clinical application and popularization of immune-enhanced enteral nutrition. Methods 70 patients with gastric cancer were randomly divided into early immunized enteral nutrition group and total parenteral nutrition group. Peripheral venous blood was collected on the first day before operation and on the 8th day after operation to detect the proportion of immune cells and the expression of surface markers, the expression of IL-2 IFN-gtTNF-a IL-10 in serum, and the clinical related indexes including hemoglobin and serum albumin. The prealbumin content and postoperative recovery were observed, and the telephone follow-up survival time was observed. Results on the 8th day after operation, most of the immunological indexes in EEIN group were significantly higher than those in TPN group, and the inflammatory index was significantly lower than that in TPN group, and the difference was statistically significant. The first exhaust time and hospital stay were significantly decreased. On the 8th day after operation, the levels of BMI index and TG were significantly higher than those in TPN group (P 0.05). The survival time without complications and the survival time without progression were significantly prolonged. Conclusion EEIN can activate immune function and improve nutritional status of patients with gastric cancer after operation. It is helpful to prolong the progressive survival and improve the quality of life.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 Wanqing Chen;Rongshou Zheng;Siwei Zhang;Ping Zhao;Guanglin Li;Lingyou Wu;Jie He;;The incidences and mortalities of major cancers in China, 2009[J];Chinese Journal of Cancer;2013年03期

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本文編號(hào)：1833828