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目的探讨贲门癌术后早期营养支持对患者术后恢复和免疫功能的影响。方法贲门癌切除术后60例患者随机均分为三组,分别实施肠内营养(EN组)、肠外营养(PN组)和两者结合(EN+PN组)。均于术后24h内开始营养支持;检测术后第1、4、7天的体液免疫指标和手术前后血清白蛋白和肝功能的变化,比较三组术后肛门排气时间和并发症发生情况。结果 EN组患者腹泻、腹胀和恶心的发生率分别为52.9%、64.7%和29.4%,高于EN+PN组的27.8%、16.7%和11.1%(P<0.05);PN组患者导管热的发生率为17.6%,高于EN+PN组的0.05%(P<0.05)。术后第7天,EN组和EN+PN组的IgM、IgG高于PN组(P<0.05),EN+PN组的补体C3和补体C4低于EN组和PN组(P<0.05)。EN组和EN+PN组术后肛门排气时间较PN组提前(P<0.05)。结论贲门癌术后早期EN较PN更有利于促进免疫功能及肠道功能恢复;两者结合可减少EN和PN相关并发症的发生。
Objective To investigate the effect of early postoperative nutritional support on postoperative recovery and immune function in patients with cardiac cancer. Methods Sixty patients after cardiac resection were randomly divided into three groups: enteral nutrition group (EN group), parenteral nutrition group (PN group) and combination of the two groups (EN + PN group). Nutritional support was started within 24 hours after operation. Changes of humoral immunity indexes and serum albumin and liver function on the 1st, 4th and 7th days after operation were compared, and the time of postoperative anal exhaust and complication were compared . Results The incidences of diarrhea, abdominal distension and nausea in EN group were 52.9%, 64.7% and 29.4% respectively, which were 27.8%, 16.7% and 11.1% higher than those in EN + PN group (P <0.05) The incidence was 17.6%, which was higher than 0.05% of EN + PN group (P <0.05). The levels of IgM and IgG in EN group and EN + PN group were higher than those in PN group on the 7th day (P <0.05). The levels of complement C3 and complement C4 in EN + PN group were lower than those in EN group and PN group (P <0.05). Postoperative anal exhaust time in EN group and EN + PN group was earlier than that in PN group (P <0.05). Conclusions Early postoperative EN for cardia cancer is better than PN in promoting immune function and intestinal function recovery. The combination of the two can reduce the incidence of EN and PN related complications.