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目的探讨不同途径营养支持对食管癌患者术后免疫功能、营养状况的影响。方法83例食管癌术后患者分为肠内营养组(EN组,40例)和肠外营养组(PN组,43例)。两组均于术后第1天开始营养支持。于术前、术后第3、7天取外周血检测白蛋白、前白蛋白、免疫球蛋白浓度(IgA、IgG、IgM)、T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+)、超敏C反应蛋白(CRP)和前列腺素E2(PGE2)。记录术后并发症和住院天数。结果 EN组术后胃液引流量较PN组少[(750.56±73.62)ml vs.(1250.85±103.77)ml](P<0.05),首次排气时间较PN组早[(53.21±5.24)h vs.(69.12±8.68)h](P<0.05),住院时间较PN组缩短[(12.4±1.6)d vs.(16.7±2.3)d](P<0.05)。EN组营养状况改善优于PN组;两组术后免疫功能均有抑制,但EN组患者在术后第3、7天免疫功能指标较PN组高(P<0.05)。两组的炎性指标在术后第3天增高,EN组术后第7天下降更为明显(P<0.05)。结论食管癌患者术后早期采用EN营养支持能更有效改善患者的营养状况和免疫功能,减轻机体的炎症反应,促进患者的恢复。
Objective To investigate the effect of different ways of nutritional support on postoperative immune function and nutritional status of esophageal cancer patients. Methods 83 cases of esophageal cancer patients were divided into enteral nutrition group (EN group, 40 cases) and parenteral nutrition group (PN group, 43 cases). Nutritional support was started on the first postoperative day in both groups. Preoperative and postoperative day 3 and 7, serum albumin, prealbumin, immunoglobulin concentrations (IgA, IgG, IgM), T lymphocyte subsets (CD3 +, CD4 +, CD4 + / CD8 + Sensitive C-reactive protein (CRP) and prostaglandin E2 (PGE2). Record postoperative complications and hospitalization days. Results The volume of postoperative gastric drainage in EN group was significantly lower than that in PN group [(750.56 ± 73.62) ml vs. (1250.85 ± 103.77) ml] (P <0.05), and the time to first deflation was (53.21 ± 5.24) h vs (69.12 ± 8.68) h] (P <0.05). The hospitalization time was shorter than that in PN group [(12.4 ± 1.6) d vs. (16.7 ± 2.3) d] (P <0.05). The nutritional status of EN group was better than that of PN group. The immune function of both groups was inhibited after operation. However, the immune function of EN group was higher than that of PN group on the 3rd and 7th day after operation (P <0.05). Inflammatory index of the two groups increased on the third day after operation, and the EN group decreased more obviously on the seventh day after operation (P <0.05). Conclusion The early use of EN nutritional support for esophageal cancer patients can effectively improve the nutritional status and immune function, reduce the inflammatory response and promote the recovery of patients.