动态营养支持对口腔颌面肿瘤术后能量代谢、免疫功能及应激反应的影响

目的：观察动态营养支持对口腔颌面部肿瘤患者术后能量代谢、免疫功能及应激反应的影响。方法：选取口腔颌面部肿瘤手术患者56例,随机分为实验组（28例）和对照组（28例）。实验组术后根据应激期给予动态肠内、肠外营养支持,并添加ω-3鱼油脂肪乳注射液及谷氨酰胺;对照组常规术后肠内、肠外营养支持。分别于术前1 d、术后2 d及7 d检测能量代谢、免疫功能及应激指标。采用SPSS 19.0软件包对数据进行统计学分析。结果：实验组前白蛋白术后第2天及血清白蛋白、前白蛋白术后第7天能量代谢指标高于对照组,实验组空腹血糖、甘油三酯术后第2天及第7天均显著低于对照组（P<0.05）。实验组术后第7天IgA、IgG、IgM、CD3⁺、CD4⁺、CD4⁺/CD8⁺水平显著高于对照组（P<0.05）。实验组术后第2天IL-6以及术后第7天CRP、TNF-α、IL-6水平显著低于对照组（P<0.05）,2组术后并发症无显著差异。结论：动态营养支持可以改善口腔颌面肿瘤术后能量代谢,提高机体免疫功能,缓解应激反应。

Effects of dynamic nutrition support on energy metabolism,immune function and stress response after oral and maxillofacial tumor surgery

PURPOSE:To observe the effect of dynamic nutrition support on postoperative energy metabolism,immune function and stress response in patients with oral and maxillofacial tumors.METHODS:Fifty-six patients with oral and maxillofacial tumor surgery were randomly divided into experimental group and control group(28 in each group).Patients in the experimental group received dynamic enteral and parenteral nutrition support according to the stress period after surgery,ω-3 fish oil fat milk injection and glutamine were added in the nutrition support program.Patients in the control group were given routine postoperative enteral and parenteral camp support.Energy metabolism,immune function and stress indexes were detected 1 day before surgery,2 days after surgery and 7 days after surgery,respectively.SPSS 19.0 software package was used to analyze the data.RESULTS:Energy metabolism indexes in the experimental group were higher than the control group on day 2 after PA surgery and day 7 after ALB and PA surgery,while energy metabolism indexes in the experimental group were lower than the control group on day 2 and day 7 after FPG and TG surgery with significant difference(P<0.05).The levels of IgA,IgG,IgM,CD3^+,CD4^+and CD4^+/CD8^+in the experimental group were higher than those in the control group 7 days after surgery,with significant differences(P<0.05).The levels of CRP,TNFand IL-6 in the experimental group were lower than those in the control group 7 days after surgery,and the difference was significant(P<0.05).There was no significant difference in postoperative complications between the two groups.CONCLUSIONS:Dynamic nutrition support can improve postoperative energy metabolism of patients with oral and maxillofacial tumors,improve immune function,and alleviate stress response.