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目的探讨胃癌术后应用谷氨酰胺和中链三酰甘油(glutamine and medinm-chain triglycer-ide enteral nutrition,GMEN)肠内营养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例患者随机分组,即肠内营养(enteral nutrition,EN)组和肠外营养(parenteral nutrition,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三酰甘油的肠内营养液,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质量(BW)、血清白蛋白(Alb)、血红蛋白(Hb)和氮平衡(NB),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反应蛋白(CRP)。同时观察术后并发症及胃肠道功能恢复时间。结果两组在体质量、血红蛋白的恢复方面差异无统计学意义(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)d,PN组为(3.66±0.89)d,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,应用含谷氨酰胺和中链三酰甘油的肠内营养液可提高患者免疫力,促进机体恢复,降低术后并发症的发生率,是一种实用有效的营养支持疗法。
Objective To investigate the feasibility and clinical value of enteral nutrition with glutamine and medinm-chain triglycer-ide enteral nutrition (GMEN) after gastric cancer surgery. Methods Sixty patients with nutritional support after gastric cancer surgery were randomly divided into enteral nutrition (EN) group and parenteral nutrition (PN) group. The nutritional support was equal to that of total nitrogen EN group with glutamine and medium chain triglyceride enteral nutrition solution, the implementation of early nutrition. Body weight (BW), serum albumin (Alb), hemoglobin (Hb) and nitrogen balance (NB), immunoassay index lymphocyte count (LCC) , IgA, IgG, IgM, CD3, CD4, CD8, CD4 / CD8, prostaglandin E-2 (PGE-2) and C-reactive protein (CRP). At the same time observe the postoperative complications and gastrointestinal function recovery time. Results There was no significant difference in body weight and hemoglobin recovery between the two groups (P = 0.305, P = 0.057). However, the recovery of albumin and nitrogen balance in EN group was faster than that in PN group, and the difference was statistically significant P = 0.017, P = 0.000). The level of IgA, IgG, CD4 and CD4 / CD8 in immunosuppressive group was significantly higher than that in PN group after operation (P = 0.000), while the level of CRP in EN group was significantly lower than that in PN group Group (P = 0.000). The incidence of postoperative complications was 46.7% in PN group and 16.7% in EN group, the difference was statistically significant (P = 0.000). The time of anus recovery was (2.46 ± 0.56) days in EN group and (3.66 ± 0.89) days in PN group, the difference was statistically significant (P = 0.000). Conclusions Early postoperative enteral nutrition for gastric cancer patients should be implemented. Enteral nutrition solution containing glutamine and medium chain triacylglycerol can improve immunity, promote the recovery of the body and reduce the incidence of postoperative complications, which is a practical Effective nutrition support therapy.