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目的 评价免疫增强型肠内营养制剂对肿瘤病人手术创伤后代谢 ,炎性反应 ,免疫功能及预后的影响。方法 88例消化道恶性肿瘤手术病人随机分为常规肠内营养组和免疫增强型肠内营养组。手术后第 1天开始等热量、等氮肠内营养支持 1周。于术前、术后第 1、4天和研究结束时分别检测多核白细胞的吞噬功能、氧化代谢情况 ,巨噬细胞NO产生量 ,IL 1、IL 2、IL 6及TNF α浓度 ,IgA、IgG、IgM ,淋巴细胞总数 ,T、B淋巴细胞数及CD4 、CD8,血清PGE2 浓度 ,CRP、α 抗胰蛋白酶和纤维蛋白原等急性相反应蛋白浓度。检测总蛋白 ,白蛋白等 ,前白蛋白、转铁蛋白及氮平衡等营养指标。同时观测研究期间病死率 ,手术后感染性并发症发生率及住院时间。结果 研究结束时 ,研究组IgA、IgG、IgM ,血淋巴细胞总数、CD3、CD4 及CD4 /CD8、多核白细胞的吞噬能力、多核白细胞的氧化代谢状况及巨噬细胞的NO产生量均明显高于对照组 (P <0 0 1) ;而血IL 6、TNF α浓度及CRP水平明显低于对照组 (P <0 0 5 )。研究期间两组白蛋白 ,每日及累积氮平衡差异无显著性 ,术后第 8天 ,研究组血浆前白蛋白及转铁蛋白浓度明显高于对照组。两组在术后 4天内的感染性并发症发生率差异无显著意义 ,但研究组术后 4天以后的感染性并发症发生率却明显低?
Objective To evaluate the effect of immune-enhanced enteral nutrition on metabolism, inflammatory response, immune function and prognosis of patients with tumor after surgical trauma. Methods Eighty-eight patients with gastrointestinal cancer were randomly divided into routine enteral nutrition group and immunocompromised enteral nutrition group. Day 1 after surgery began to wait for heat, and other nitrogen enteral nutrition support for 1 week. Phagocytic function, oxidative metabolism, NO production of macrophages, IL 1, IL 2, IL 6 and TNFα levels, IgA, IgG were detected preoperatively, on the 1st and 4th postoperative day, and at the end of the study. , IgM, the total number of lymphocytes, T, B lymphocytes and CD4, CD8, serum PGE2 concentration, CRP, alpha antitrypsin and fibrinogen and other acute phase protein concentration. Detection of total protein, albumin, prealbumin, transferrin and nitrogen balance and other nutritional indicators. At the same time, the case fatality rate, incidence of postoperative infectious complications and length of hospital stay were observed. Results At the end of the study, IgA, IgG, IgM, total number of blood lymphocytes, CD3, CD4 and CD4 / CD8, phagocytosis of polymorphonuclear leukocytes, oxidative metabolism of polymorphonuclear leukocytes and NO production of macrophages were all significantly higher (P <0.01). However, the levels of IL-6, TNF-α and CRP in serum were significantly lower than those in the control group (P <0 05). There were no significant differences in daily and cumulative nitrogen balance between the two groups during the study. On the 8th day after surgery, the concentrations of prealbumin and transferrin in the study group were significantly higher than those in the control group. There was no significant difference in the incidence of infectious complications between the two groups within 4 days after operation, but the incidence of infectious complications in study group after 4 days was significantly lower.