胃癌术后应用含谷氨酰胺和中链甘油三酯早期肠内营养的临床研究

目的 探讨胃癌术后早期应用含谷氨酰胺和中链甘油三酯肠内营养(GMEN)的可行性和临床应用价值.方法 选择胃癌术后需要营养支持的60例患者随机分为肠内营养(EN)组和肠外营养(PN)组,两组营养支持均等热量、等氮量,其中EN组选用含谷氨酰胺和中链甘油三酯的肠内营养液,实施早期营养.分别于术前第1天、术后第8天检测营养评定指标体重、血清白蛋白(A1b)、血红蛋白(Hb)和氮平衡,免疫评定指标淋巴细胞计数(LCC)、IgA、IgG、IgM、CD3、CD4、CD8、CD4/CD8、前列腺素E-2(PGE-2)和C反映蛋白(CRP).同时观察术后并发症及胃肠道功能恢复时间.结果 两组在体重、血红蛋白的恢复方面没有统计学差异(P=0.305,P=0.057),但EN组的白蛋白及氮平衡恢复较PN组为快,组间差异有统计学意义(P=0.017,P=0.000).反映免疫指标的淋巴细胞、IgA、IgG、CD4、CD4/CD8在术后EN组较PN组明显升高,差异有统计学意义(P=0.000),而术后CRP在EN组明显低于PN组(P=0.000).术后并发症发生率,PN组为46.7%,EN组为16.7%,差异有统计学意义(P=0.000).肛门恢复排气时间EN组为(2.46±0.56)天,PN组为(3.66±0.89)天,差异有统计学意义(P=0.000).结论 胃癌术后患者实施早期肠内营养,应用GMEN可提高患者免疫力,促进机体恢复,降低术后并发症的发生率,是一种实用有效的临床营养支持方法.

A Clinical Study on Early Using Glutamine and Medium-Chain Triglyceride Enteral Nutrition for Postoperative Patients with Gastric Carcinoma

Objective To investigate the possibility and acute role of glutamine and medium-chain triglyceride enteral nutrition(GMEN) support in postoperative patients with gastric carcinoma .Methods Sixty postoperative patients with gastric carcinoma who required nutrition support were randomly divided into enteral nutrition(EN) group and parenteral nutrition(PN) group,and received isonitrogenic and isocaloric nutrition per kilogram every day.Nutrient material was supplied with glutamine and medium-chain triglyceride in EN.On the day before and the 8th day after operation,the nutrient indexes and the immune indexes were monitored carefully.Complications and resumptions of gastrointestinal function were closely observed.Results The value of body weight and hemoglobin in EN were higher than those in PN,but there was no significant difference between the two groups(P>0.05).Album and nitrogen balance increased evidently in EN group than those in PN group(P=0.017,P= 0.000).The value of lymphocyte and IgA and IgG and CD4 and CD4/CD8 in EN group were higher than those in PN group.There was significant difference between the two groups(P=0.000).But CRP in EN group was obviously lower than that in PN group(P=0.000).The morbidity rate was 16.7% in EN group and 46.7% in PN group(P=0.000).Conclusions GMEN can improve the immune function and the efficiency of operation and may be an available way for postoperative patients with gastric carcinoma.