【摘要】：目的研究胃癌患者術后早期經(jīng)口進食腸內(nèi)營養(yǎng)制劑的安全性及其對患者短期臨床結局、營養(yǎng)狀態(tài)、免疫功能和應激水平的影響。方法選取青島大學附屬醫(yī)院普外科2015.7-2016.10收治胃癌患者90例,通過隨機數(shù)字表法分為試驗組45例和對照組45例。最后參與到研究中試驗組患者38例,對照組患者42例,總共80例。試驗組患者術后早期經(jīng)口進食水和腸內(nèi)營養(yǎng)制劑,對照組患者采用術后常規(guī)圍手術期治療方案;記錄兩組患者術后的發(fā)熱時間、排氣時間、住院時間、住院費用等比較短期臨床結局;記錄兩組患者術前1天及術后1、3、7天血清白蛋白、前白蛋白、視黃醇結合蛋白比較營養(yǎng)狀態(tài);記錄兩組患者術前1天及術后1、3、7天CD4+T、CD4+T/CD8+T、Ig G、Ig M、Ig A比免疫功能;記錄術前1天及術后1、3、7天CRP、IL-6、Tnf-α比較應激水平;記錄試驗組術后第2到第6天早期經(jīng)口腸內(nèi)營養(yǎng)完成率。結果兩組患者相比較,試驗組的術后發(fā)熱時間[(74.63±7.56)h比(80.33±8.57)h,P0.05]、排氣時間[(75.24±6.17)h比(80.74±8.58)h,P0.05]、術后住院時間[(8.24±2.46)d比(9.5±1.66)d,P0.05]比對照組短,住院費用[(58.18±5)千元比(63.04±4.36)千元,P0.05]明顯減少。試驗組與對照組的并發(fā)癥發(fā)生率對比無明顯差異[13.2%(5/38)比16.7%(7/42),PO.05];試驗組患者術前1天及術后第1、3天血清白蛋白與對照組無明顯差異(P0.05),試驗組患者術后第7天血清白蛋白高于對照組(P0.05)。試驗組患者術前1天及術后第1天血清前白蛋白及視黃醇結合蛋白與對照組無明顯差異(P0.05),試驗組術后第3天及第7天的血清前白蛋白和視黃醇結合蛋白高于對照組(P0.05);試驗組患者術前1天及術后第1、3天CD4+T與對照組無明顯差異(P0.05),試驗組患者術后第7天的CD4+T高于對照組(P0.05)。試驗組患者術前1天及術后第1天CD4+T/CD8+T與對照組無明顯差異(P0.05),試驗組患者術后第3天和第7天的CD4+T/CD8+T高于對照組(P0.05);試驗組患者術前1天及術后第1天Ig G、Ig M、Ig A與對照組無明顯差異(均P0.05),試驗組患者術后第3天和第7天的Ig G、Ig M、Ig A高于對照組(均P0.05);試驗組患者術前1天及術后第1天CRP、IL-6、Tnf-α與對照組無明顯差異(均P0.05),試驗組患者術后第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。結論胃癌患者術后早期經(jīng)口進食腸內(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,降低應激水平,改善胃癌患者術后的短期臨床結局。
[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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.2

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