目的 探讨肠内营养干预对胃肠道肿瘤患者术后炎性反应和预后的影响。方法 选取2015-04至2016-02我院普外科住院行胃肠道肿瘤根治术切除手术的患者90例，随机分为肠内营养干预组和肠外营养组，每组45例，分别进行肠内营养干预和肠外营养治疗，并于术前1 d，术后 1、 3、9 d分别抽取清晨空腹静脉血检测CRP、IL-6、TNF-α，观察预后情况。结果 肠内营养干预组和肠外营养组两组患者CRP、IL-6、TNF-α差异均有统计学意义(F分组＝26.381、17.574、23.546，均P＜0.05);CRP、IL-6、TNF-α术后1 d均升高(均P＜0.05)，CRP、IL-6术后3 d均降低(均P＜0.05)，其中仅IL-6术后9 d恢复至术前1 d水平，TNF-α术后9 d显著降低，但仍高于术前1 d水平;肠内营养干预组CRP、IL-6、TNF-α降低幅度均大于肠外营养组(F交互＝9.542、6.876、7.958，均P＜0.05)。肠内营养干预组的肠鸣音恢复时间、首次肛门排气时间、首次肛门排便时间、术后住院天数均明显低于肠外营养组，且具有统计学差异(均P＜0.05);肠内营养干预组切口感染、肺部感染、泌尿系统感染发生率均低于肠外营养组，且具有统计学差异(均P＜0.05)。结论 肠内营养干预可以减轻胃肠道肿瘤患者术后的炎性反应，并改善预后。
Abstract
Objective To investigate the effect of enteral nutrition on postoperative inflammatory reaction and prognosis in patients with gastrointestinal tumor. Methods 90 patients with gastrointestinal tumor in the Department of General Surgery in this hospital from April 2015 to February 2016 were recruited as the research objects. The patients were randomly divided into enteral nutrition intervention group (45 patients) and parenteral nutrition group (45 patients). Fasting venous blood in the morning of 1d before the operation, 1, 3, 9 d after the operation was collected, to test CRP, IL-6, TNF-α, and the prognoses of the patients were observed.Results There were significant differences in CRP, IL-6 and TNF-α between the two groups of patients with enteral nutrition and parenteral nutrition(Fgroup＝26.381, 17.574, 23.546, all P<0.05). CRP, IL-6 and TNF-α were significantly increased after 1d(all P<0.05), CRP, IL-6 3 d after operation were significantly reduced(all P<0.05), among them, only IL-6 9 d after operation recovered to preoperative 1 d level, TNF-α significantly decreased 9 d after operation, but it was still higher than preoperative 1 d level. The reduction of CRP, IL-6 and TNF-α in the enteral nutrition intervention group were higher than those in the parenteral nutrition group(Finteractive＝9.542, 6.876, 7.958, all P<0.05). In enteral nutrition intervention group, the recovery time of bowel sounds, first anal exhaust time, first anal defecation time, postoperative hospitalization days were significantly lower than those in the parenteral nutrition group and had significant differences(all P<0.05). The incidence of incision infection, pulmonary infection and urinary system infection in the intestinal nutrition intervention group were lower than those in the parenteral nutrition group and the differences were statistically significant(all P<0.05).Conclusions Enteral nutrition intervention can reduce postoperative inflammatory reaction and improve the prognosis of patients with gastrointestinal tumor.
关键词
肠内营养 /
胃肠肿瘤 /
炎性反应 /
预后
Key words
enteral nutrition /
gastrointestinal tumor /
inflammatory response /
prognosis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Daniela T, Nelson S A, Bo-Hyun M,et al. High-energy particle-induced tumorigenesis throughout the gastrointestinal tract [J]. Radiat Res, 2014, 181(2): 162-171.
[2] 罗世政. 奥沙利铂联合卡培他滨治疗晚期结直肠癌30例临床疗效分析[J]. 贵州医药, 2014, 38(4): 340-341.
[3] Schmidt S, Dunet V, Koehli M, et al. Diffusion-weighted magnetic resonance imaging in metastatic gastrointestinal stromal tumor (GIST): a pilot study on the assessment of treatment response in comparison with 18F-FDG PET/CT [J]. Acta Radiologica, 2013, 54(8): 837-842.
[4] Liu Q, Liu Z, Chen H, et al. Treatment with growth hormone, somatostatin, and insulin in combination with hypocaloric parenteral nutrition in gastrointestinal cancer patients after surgery [J]. Nutrition, 2011, 27(6): 633-640.
[5] Ma C J, Sun L C, Chen F M, et al. A double-blind randomized study comparing the efficacy and safety of a composite vs a conventional intravenous fat emulsion in postsurgical gastrointestinal tumor patients [J]. Nutr Clin Pract, 2012, 27(3): 410-415.
[6] Regan K N, Shinagare A B, Saboo S S, et al. Gastrointestinal stromal tumors (GIST):lesser known facts[J]. Clin Imag, 2013, 37(5): 821-829.
[7] 蒋 欢, 蒋丽琳, 张 凯,等. 早期肠内营养联合双歧杆菌三联活菌胶囊治疗重症急性胰腺炎的疗效及对炎性因子、肠黏膜屏障功能保护的影响[J]. 海南医学院学报, 2015, 21(11): 1496-1498.
[8] 潘继承, 朱建一, 史恒川, 等. 血清TNF-α、hs-CRP和PA检测在老年慢性阻塞性肺疾病中的临床价值[J]. 实用老年医学, 2012, 26(4): 293-295.
[9] Riedel M, Voit B. Synthesis of multifunctional polymers by combination of controlled radical polymerization (CRP) and effective polymer analogous reactions [J]. Pure Appl Chem, 2013, 85(3): 557-571.
[10] Wang M S, Black J C, Knowles M K, et al. C-reactive protein (CRP) aptamer binds to monomeric but not pentameric form of CRP [J]. Anal Bioanal Chem, 2011, 401 (4): 1309-1318.
[11] Soo K L, Hyun C K, Sang J C, et al. Binding behavior of CRP and anti-CRP antibody analyzed with SPR and AFM measurement [J]. Ultramicroscopy, 2008, 108(10):1374-1378.
[12] Goergens S W, Eckardt K, Elsen M, et al. Chitinase-3-like protein 1 protects skeletal muscle from TNF alpha-induced inflammation and insulin resistance [J]. Biochem J, 2014, 459(3): 479-488.
[13] Masuda K, Ripley B, Nishimura R, et al. Arid 5a controls IL-6 mRNA stability, which contributes to elevation of IL-6 level in vivo[J]. PNAS, 2013, 110(23): 9409-9414.
[14] Galan M G, Drago S R. Food matrix and cooking process affect mineral bioaccessibility of enteral nutrition formulas [J]. J Sci Food Agricul, 2014,94(3):515-521.
[15] Nagano T, Fujita H, Tanaka T, et al. A randomized controlled trial comparing antioxidant -enriched enteral nutrition with immune-enhancing enteral nutrition after esophagectomy for cancer: a pilot study [J]. Surg Today, 2013, 43(11): 1240-1249.
PDF(653 KB)
