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目的观察谷氨酰胺胃肠外营养(Gln-TPN)对胃肠道恶性肿瘤老年患者术后营养及免疫功能的影响。方法选择2009-2013年入住本院的胃肠道恶性肿瘤老年患者40例,随机分成两组,即谷氨酰胺强化的胃肠外营养组(Gln-TPN组)和标准胃肠外营养组(S-TPN组),每组20例。所有患者均于术后第2 d至第6~8 d,接受5~7 d的全胃肠外营养支持治疗。Gln-TPN组患者在S-TPN组的基础上加入谷氨酰胺(一日0.3~0.6 g/kg)。术前及术后第7 d测患者白蛋白、谷丙转氨酶(ALT);自然杀伤细胞(NK细胞)、CD3+、CD4+、CD8+细胞水平,CD4+/CD8+比值;IgG、IgM水平;并观察患者胃肠道功能恢复情况。结果与S-TPN组相比,Gln-TPN组患者术后第7 d血清白蛋白水平、NK细胞、CD3+、CD4+、CD8+细胞百分比,CD4+/CD8+比值;免疫球蛋白IgG、IgM水平均增高,且组间差异具有统计学意义(P<0.05)。S-TPN组术后免疫功能低于术前水平,而Gln-TPN组却超过了术前水平,组间差异具有统计学意义(P<0.05)。术后Gln-TPN组胃肠功能的恢复时间也显著少于S-TPN组(P<0.05)。结论 Gln-TPN可改善胃肠道肿瘤老年患者术后的营养状况,提高机体免疫功能,减轻术后应激反应,有助于患者康复。
Objective To observe the effects of glutamine parenteral nutrition (Gln-TPN) on nutritional status and immune function in elderly patients with gastrointestinal cancer. Methods Forty elderly patients with gastrointestinal cancer admitted to our hospital from 2009 to 2013 were randomly divided into two groups: glutamine-enhanced parenteral nutrition group (Gln-TPN group) and standard parenteral nutrition group S-TPN group), 20 cases in each group. All patients received total parenteral nutrition support 5-7 days after operation from day 2 to day 6-8. Gln-TPN group patients in the S-TPN group based on the addition of glutamine (0.3 ~ 0.6 g / kg on the 1st). The levels of albumin, alanine aminotransferase (ALT), natural killer (NK) cells, CD3 +, CD4 + and CD8 + cells, CD4 + / CD8 + ratio, IgG and IgM levels were measured before and 7 days after operation. Intestinal function recovery. Results Compared with the S-TPN group, serum albumin level, NK cell, CD3 +, CD4 +, CD8 + cell percentage and CD4 + / CD8 + ratio in the Gln-TPN group were significantly increased on the 7th day after operation The difference between the two groups was statistically significant (P <0.05). The immune function of S-TPN group was lower than that of preoperative level, but Gln-TPN group was higher than the preoperative level, the difference was statistically significant (P <0.05). The recovery time of gastrointestinal function in Gln-TPN group was also significantly less than that in S-TPN group (P <0.05). Conclusion Gln-TPN can improve the nutritional status of elderly patients with gastrointestinal cancer, improve immune function, reduce postoperative stress response, and help patients recover.