【摘要】：目的研究胃癌患者術(shù)后早期經(jīng)口進(jìn)食腸內(nèi)營養(yǎng)制劑的安全性及其對患者短期臨床結(jié)局、營養(yǎng)狀態(tài)、免疫功能和應(yīng)激水平的影響。方法選取青島大學(xué)附屬醫(yī)院普外科2015.7-2016.10收治胃癌患者90例,通過隨機(jī)數(shù)字表法分為試驗(yàn)組45例和對照組45例。最后參與到研究中試驗(yàn)組患者38例,對照組患者42例,總共80例。試驗(yàn)組患者術(shù)后早期經(jīng)口進(jìn)食水和腸內(nèi)營養(yǎng)制劑,對照組患者采用術(shù)后常規(guī)圍手術(shù)期治療方案;記錄兩組患者術(shù)后的發(fā)熱時(shí)間、排氣時(shí)間、住院時(shí)間、住院費(fèi)用等比較短期臨床結(jié)局;記錄兩組患者術(shù)前1天及術(shù)后1、3、7天血清白蛋白、前白蛋白、視黃醇結(jié)合蛋白比較營養(yǎng)狀態(tài);記錄兩組患者術(shù)前1天及術(shù)后1、3、7天CD4+T、CD4+T/CD8+T、Ig G、Ig M、Ig A比免疫功能;記錄術(shù)前1天及術(shù)后1、3、7天CRP、IL-6、Tnf-α比較應(yīng)激水平;記錄試驗(yàn)組術(shù)后第2到第6天早期經(jīng)口腸內(nèi)營養(yǎng)完成率。結(jié)果兩組患者相比較,試驗(yàn)組的術(shù)后發(fā)熱時(shí)間[(74.63±7.56)h比(80.33±8.57)h,P0.05]、排氣時(shí)間[(75.24±6.17)h比(80.74±8.58)h,P0.05]、術(shù)后住院時(shí)間[(8.24±2.46)d比(9.5±1.66)d,P0.05]比對照組短,住院費(fèi)用[(58.18±5)千元比(63.04±4.36)千元,P0.05]明顯減少。試驗(yàn)組與對照組的并發(fā)癥發(fā)生率對比無明顯差異[13.2%(5/38)比16.7%(7/42),PO.05];試驗(yàn)組患者術(shù)前1天及術(shù)后第1、3天血清白蛋白與對照組無明顯差異(P0.05),試驗(yàn)組患者術(shù)后第7天血清白蛋白高于對照組(P0.05)。試驗(yàn)組患者術(shù)前1天及術(shù)后第1天血清前白蛋白及視黃醇結(jié)合蛋白與對照組無明顯差異(P0.05),試驗(yàn)組術(shù)后第3天及第7天的血清前白蛋白和視黃醇結(jié)合蛋白高于對照組(P0.05);試驗(yàn)組患者術(shù)前1天及術(shù)后第1、3天CD4+T與對照組無明顯差異(P0.05),試驗(yàn)組患者術(shù)后第7天的CD4+T高于對照組(P0.05)。試驗(yàn)組患者術(shù)前1天及術(shù)后第1天CD4+T/CD8+T與對照組無明顯差異(P0.05),試驗(yàn)組患者術(shù)后第3天和第7天的CD4+T/CD8+T高于對照組(P0.05);試驗(yàn)組患者術(shù)前1天及術(shù)后第1天Ig G、Ig M、Ig A與對照組無明顯差異(均P0.05),試驗(yàn)組患者術(shù)后第3天和第7天的Ig G、Ig M、Ig A高于對照組(均P0.05);試驗(yàn)組患者術(shù)前1天及術(shù)后第1天CRP、IL-6、Tnf-α與對照組無明顯差異(均P0.05),試驗(yàn)組患者術(shù)后第3天和第7天的CRP、IL-6、Tnf-α均低于對照組(均P0.05)。試驗(yàn)組內(nèi)第2到6天經(jīng)口服用腸內(nèi)營養(yǎng)制劑完成率逐漸增加。結(jié)論胃癌患者術(shù)后早期經(jīng)口進(jìn)食腸內(nèi)營養(yǎng)制劑是安全的,能夠改善患者營養(yǎng)狀態(tài)、免疫功能,降低應(yīng)激水平,改善胃癌患者術(shù)后的短期臨床結(jié)局。
[Abstract]:Objective to study the safety of enteral nutrition in early postoperative gastric cancer patients and its effect on the short-term clinical outcome, nutritional status, immune function and stress level. Methods 90 patients with gastric cancer were randomly divided into trial group (n = 45) and control group (n = 45). Finally, there were 38 patients in the trial group and 42 patients in the control group. The patients in the trial group received oral water and enteral nutrition early after operation, while the patients in the control group were treated with routine perioperative treatment. The postoperative fever time, exhaust time, hospitalization cost and so on were recorded in the two groups. The nutritional status of serum albumin, prealbumin and retinol binding protein were recorded 1 day before operation and 1 day after operation. The specific immunological function of CD4 T 4, T/CD8, Ig, Ig and Ig A were recorded 1 day before operation and 1 day and 3 days after operation, and the stress levels of CRP,IL-6,Tnf- 偽 were recorded 1 day before operation and 1 day after operation, 3 days after operation, 1 day before operation and 1 day after operation. The rate of early oral enteral nutrition in the trial group was recorded 2 to 6 days after operation. Results the postoperative fever time was (74.63 鹵7.56) h vs (80.33 鹵8.57) h, the exhaust time was (75.24 鹵6.17) h vs (80.74 鹵8.58) h in the experimental group. The postoperative hospitalization time [(8.24 鹵2.46) days vs (9.5 鹵1.66) d] was shorter than that of the control group [(58.18 鹵5) thousand yuan vs (63.04 鹵4.36) thousand yuan, P0.05]. There was no significant difference in the incidence of complications between the trial group and the control group [13.2% (5 / 38) vs 16.7% (7 / 42), PO.05]; There was no significant difference in serum albumin between the test group and the control group on the 1st day before operation and the 1st day after operation (P0.05). The serum albumin in the test group was higher than that in the control group on the 7th day after operation (P0.05). There was no significant difference in serum prealbumin and retinol binding protein between the test group and the control group 1 day before and 1 day after operation (P0.05). The levels of serum prealbumin and retinol binding protein in the experimental group were higher than those in the control group on the 3rd and 7th day after operation (P0.05). There was no significant difference in CD4 T between the test group and the control group 1 day before operation and 1 day after operation (P0.05). The CD4 T of the test group was higher than that of the control group on the 7th day after operation (P0.05). There was no significant difference in CD4 T/CD8 T between the test group and the control group on the first day before operation and on the first day after operation (P0.05). The CD4 T/CD8 T of the trial group was higher than that of the control group on the 3rd and 7th day after operation (P0.05). There was no significant difference between the patients of the trial group and the control group on the first day before operation and on the first day after operation (P0.05), and the Ig GG Ig A of the patients in the trial group was higher than that of the control group on the 3rd and 7th day after operation (P0.05). There was no significant difference in CRP,IL-6,Tnf- 偽 between the test group and the control group on the first day before operation and on the first day after operation (P0.05). The CRP,IL-6,Tnf- 偽 of the test group was lower than that of the control group on the 3rd and 7th day after operation (P0.05). The completion rate of oral enteral nutrition in the trial group increased gradually from day 2 to day 6. Conclusion it is safe for gastric cancer patients to take enteral nutrition preparation early after operation, which can improve the nutritional status, immune function, reduce stress level and improve the short-term clinical outcome of gastric cancer patients.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 余穩(wěn)穩(wěn);陶瑞雨;閆開旭;韓曉鵬;李洪濤;劉宏斌;;腹腔鏡下遠(yuǎn)端胃癌根治術(shù)后患者早期經(jīng)口進(jìn)食的臨床研究[J];中國普外基礎(chǔ)與臨床雜志;2016年11期

2 江志偉;黎介壽;;規(guī)范化開展加速康復(fù)外科幾個(gè)關(guān)鍵問題[J];中國實(shí)用外科雜志;2016年01期

3 陳金標(biāo);羅漣;;早期經(jīng)口腸內(nèi)營養(yǎng)對結(jié)直腸癌患者術(shù)后免疫功能及生存質(zhì)量影響[J];中國普通外科雜志;2015年12期

4 王東升;仲蓓;趙萍;劉曉東;周巖冰;;術(shù)后早期經(jīng)口腸內(nèi)營養(yǎng)對結(jié)直腸癌患者康復(fù)和免疫功能的影響[J];中華普通外科雜志;2015年01期

5 周志軍;張常華;夏光概;向臻;魏哲威;朱錦濤;何裕隆;;腸內(nèi)免疫營養(yǎng)對胃腸道惡性腫瘤病人術(shù)后近期結(jié)局影響Meta分析[J];中國實(shí)用外科雜志;2015年01期

6 王東升;仲蓓;趙萍;劉曉東;周巖冰;;結(jié)直腸癌患者術(shù)后早期給予腸內(nèi)營養(yǎng)的隨機(jī)對照研究[J];中華胃腸外科雜志;2014年10期

7 黃彪;王琦三;;早期腸內(nèi)和腸外營養(yǎng)對胃癌病人術(shù)后免疫功能影響的系統(tǒng)評價(jià)[J];腸外與腸內(nèi)營養(yǎng);2014年01期

8 劉昭暉;蘇國強(qiáng);張思宇;張景斌;黃小蓉;;老年胃癌術(shù)后早期營養(yǎng)支持方式臨床研究[J];中華胃腸外科雜志;2013年11期

9 吳治敏;劉華英;;腹腔鏡下子宮肌瘤手術(shù)后早進(jìn)食時(shí)間的研究[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2014年03期

10 尚軼;梁會;王志凡;賈云兵;;全胃切除術(shù)后腸內(nèi)營養(yǎng)和腸外營養(yǎng)的Meta分析[J];腸外與腸內(nèi)營養(yǎng);2013年05期

，

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