标题：贲门癌术后早期肠内营养对患者肠黏膜屏障的保护及机体免疫细胞功能的影响

      作者：王新波，席江伟，罗冰清，孙太冉，石玉宝    (河北北方学院附属第二医院普通外科，河北 宣化 075100)

      卷次： 2017年28卷23期

      【摘要】 目的 探讨贲门癌术后早期肠内营养对患者肠黏膜屏障的保护作用和机体免疫细胞功能的影响。方法 选取河北北方学院附属第二医院普通外科2015年2月至2017年1月期间收治的行经腹手术治疗的贲门癌患者94例，按随机数表法分为肠内营养组与肠外营养组各47例。肠内营养组手术过程中在十二指肠悬韧带的20~30 cm部位留置经鼻营养管，术后第2天开始经营养管灌注肠内营养制剂，持续灌注7~10 d。肠外营养组手术后使用标准3 L营养袋由中心静脉进行补液，持续肠外营养7~10 d。比较两组患者术后排气与排便时间、住院总时间及并发症等情况，比较两组患者手术后血清中二胺氧化酶(DAO)水平、D-乳酸水平、血浆内毒素及免疫球蛋白(IgA、IgG、IgM)、肿瘤坏死因子-α (TNF-α)、白细胞介素(IL-6)、Ｔ淋巴细胞亚群(包括CD4、CD8以及CD4/CD8)等免疫功能指标。结果 肠内营养组患者术后排气时间、术后首次排便时间及住院总时间较肠外营养组明显缩短，差异均有统计学意义(P<0.05)；肠内营养组患者术后应激性溃疡、急性呼衰、急性呼吸窘迫、急性心衰发生率分别为 0、2.1%、2.1%、0，均明显低于肠外营养组的10.6%、8.5%、10.6%、4.3%，差异均有统计学意义(P<0.05)；肠内营养组患者术后第7天时血清中DAO与D-乳酸含量、血浆内毒素水平明显低于肠外营养组，差异均有统计学意义(P<0.05)；术后第 7天，肠内营养组患者的 IgA、IgG、IgM水平明显高于肠外营养组，差异均有统计学意义(P<0.05)，而TNF-α、IL-6水平则明显低于同期肠外营养组，差异均有统计学意义(P<0.05)；术后第 7天，肠内营养组患者的CD4以及CD4/CD8水平明显高于同期的肠外营养组，差异均有统计学意义(P<0.05)。结论 相较于肠外营养，贲门癌患者术后早期采取肠内营养治疗可以有效保护肠道黏膜机械屏障，提高营养状态，减少多种器官功能衰竭的发生，并且更加显著地提高术后机体的免疫功能。
      【关键词】 贲门癌；肠内营养；肠外营养；肠黏膜屏障；免疫功能
      【中图分类号】 R735 【文献标识码】 A 【文章编号】 1003—6350（2017）23—3847—04

Effect of early enteral nutrition on protection of intestinal mucosal barrier and immune cell function in patientsof cardiac cancer after surgery.
WANG Xin-bo, XI Jiang-wei, LUO Bing-qing, SUN Tai-ran, SHI Yu-bao. Departmentof General Surgery, the Second Affiliated Hospital of Hebei North University, Xuanhua 075100, Heibei, CHINA
【Abstract】 Objective To investigate effect of early enteral nutrition on the protection of intestinal mucosal bar-rier and immune cell function after resection of cardiac cancer. Methods A total of 94 patients with cardiac cancerwho underwent transabdominal surgery in Department of General Surgery in the Second Affiliated Hospital of HebeiNorth University from February 2015 to January 2017 were selected. According to the random number table, the pa-tients were randomly divided into enteral nutrition group (n=47) and parenteral nutrition group (n=47). Enteral-nutri-tion group experienced enteral nutrition from the 2nd day after surgery via indwelling nasal tube at 20-30 cm of sus-pensory ligament of the duodenum, for continuous 7-10 d. In parenteral-nutrition group, the infusion was conductedvia central vein with standard 3L nutrition bag, for continuous 7-10 d. The postoperative exhaust and defecation time,the total hospitalization time and complications were compared between the two groups. The levels of serum diamineoxidase (DAO), plasma endotoxin, D-lactic acid, and immunoglobulin (IgA, IgG, IgM), tumor necrosis factor alpha(TNF-α), interleukin (IL-6), T lymphocyte subsets (CD4, CD8 and CD4/CD8) were compared between the two groupsafter surgery. Results The postoperative exhaust time, the first defecation time, and the total hospitalization time ofthe enteral nutrition group were significantly shorter than those in the parenteral nutrition group (P<0.05). The postop-erative incidences of stress ulcer, acute respiratory failure, acute respiratory distress, acute heart failure rate in enteralnutrition group were 0, 2.1%, 2.1%, 0, respectively, which were significantly lower than 10.6%, 8.5%, 10.6%, 4.3% inparenteral nutrition group (P<0.05). The levels of DAO, D-lactate, and endotoxin of enteral nutrition group were signif-icantly lower than those of the parenteral nutrition group at 7 d after operation (P<0.05). 7 d after operation, the levelsof IgA, IgG and IgM in the enteral nutrition group were significantly higher than those in the parenteral nutrition group·论 著·doi:10.3969/j.issn.1003-6350.2017.23.020