【摘要】：目的:研究谷氨酰胺聯(lián)合ω-3多不飽和脂肪酸(ω-3 polyunsaturated fatty acid,PUFA)腸外營(yíng)養(yǎng)支持對(duì)結(jié)直腸癌患者術(shù)后營(yíng)養(yǎng)狀況和免疫功能的影響。方法:選擇行結(jié)直腸癌根治術(shù)的患者96例隨機(jī)分入谷氨酰胺聯(lián)合ω-3多不飽和脂肪酸腸外營(yíng)養(yǎng)(ω-3 PUFA+Gln)組、谷氨酰胺強(qiáng)化腸外營(yíng)養(yǎng)(Gin)組和常規(guī)腸外營(yíng)養(yǎng)(對(duì)照)組,各組32例。三組病人從手術(shù)結(jié)束開(kāi)始接受等氮和等熱量營(yíng)養(yǎng)支持至少7天,試驗(yàn)組營(yíng)養(yǎng)液另加谷氨酰胺注射液和ω-3多不飽和脂肪酸注射液,靜脈滴注。然后,分別于術(shù)前、術(shù)后第1天、術(shù)后第7天檢測(cè)并比較體質(zhì)量(BW)、白蛋白(ALB)、血紅蛋白(HGB)、前白蛋白(TF)、轉(zhuǎn)鐵蛋白(PA)、外周血T淋巴細(xì)胞亞群(CD4+、CD8+)、CD4+/CD8+、IgG、IgM、IgA,并比較3組術(shù)后并發(fā)癥發(fā)生率和術(shù)后住院時(shí)間。采用SAS 9.2統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析,P值小于0.05表示有統(tǒng)計(jì)學(xué)意義。結(jié)果:三組術(shù)后第1天、第7天血紅蛋白、血清白蛋白、前白蛋白和轉(zhuǎn)貼蛋白均較術(shù)前降低(P0.05),術(shù)后第7天ω-3 PUFA+Gln組血清前白蛋白水平高于Gin組和對(duì)照組(P 0.05)。三組術(shù)后第1天lg G、lgA、lgM、CD4+,CD8+, CD4+/CD8+均較術(shù)前下降(P 0.05);術(shù)后第7天ω-3 PUFA+Gln組免疫學(xué)指標(biāo)與術(shù)前比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P 0.05),術(shù)后第7天Gin組和對(duì)照組部分免疫學(xué)指標(biāo)仍低于術(shù)前(P 0.05)。co-3 PUFA+Gln組與對(duì)照組的術(shù)后總的并發(fā)癥發(fā)生率比較差異有統(tǒng)計(jì)學(xué)意義(χ2=14.930, P0.05); ω-3 PUFA+Gln組與Gin組的術(shù)后總的并發(fā)癥發(fā)生率比較差異有統(tǒng)計(jì)學(xué)意義(χ2=8.772,P0.05);Gln組與對(duì)照組的術(shù)后總的并發(fā)癥發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2 =0.933,P 0.05)。co-3 PUFA+Gln組、Gln組、對(duì)照組的術(shù)后住院時(shí)間分別為(9.8±3.1) d、(9.5±2.9)d和(12.2±3.9) d,ω-3 PUFA+Gln組與對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(t0.05/2,31=4.758,P 0.001); Gln組與對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(t0.05/2,31=4.860,P 0.001); ω-3 PUFA+Gln組與Gln組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(t0.05/2,31=0.292, P=0.771)。結(jié)論:co-3 PUFA與Gln聯(lián)合應(yīng)用可改善結(jié)直腸癌患者術(shù)后免疫功能和營(yíng)養(yǎng)狀況,并減少術(shù)后并發(fā)癥,縮短術(shù)后住院時(shí)間。
[Abstract]:Aim: to study the effect of glutamine combined with omega-3 polysaturated fatty acid (omega-3 polyunsaturated fatty acid,PUFA) parenteral nutrition support on postoperative nutritional status and immune function in patients with colorectal cancer. Methods: 96 patients undergoing radical resection of colorectal cancer were randomly divided into glutamine combined with omega-3 polysaturated fatty acid parenteral nutrition (omega-3 PUFA Gln) group). Glutamine fortified parenteral nutrition (Gin) group and routine parenteral nutrition group (control) group, 32 cases in each group. The patients in the three groups received equal nitrogen and equal calorie nutritional support for at least 7 days from the end of the operation. The experimental group was treated with glutamine injection and omega-3 polysaturated fatty acid injection intravenously. Then, the peripheral blood T lymphocyte subsets (CD4) of (BW), albumin (ALB), hemoglobin (HGB), prealbumin (TF), transferrin (PA), were measured and compared before operation, on the first day after operation and on the 7th day after operation. CD8, CD4 / CD8 and IgG,IgM,IgA, were used to compare the incidence of postoperative complications and hospital stay in the three groups. The statistical analysis was carried out by using SAS 9.2 statistical software, and the P value was less than 0.05. it was statistically significant. Results: hemoglobin, serum albumin, prealbumin and transferable protein in the three groups were lower than those before operation on the 1st and 7th day after operation (P 0.05). On the 7th day after operation, the level of serum prealbumin in omega-3 PUFA Gln group was higher than that in Gin group and control group (P 0.05). On the first day after operation, lg G, LG A, LG M, CD 4, CD8 and CD4 / CD8 in the three groups were lower than those before operation (P 0.05). There was no significant difference in immunological indexes between omega-3 PUFA Gln group and preoperative group on the 7th day after operation (P 0.05). On the 7th day after operation, some immunological indexes in Gin group and control group were still lower than those before operation (P 0.05). There was significant difference in the incidence of postoperative complications between co-3 PUFA Gln group and control group (蠂 2 鈮，

本文編號(hào)：2479316