围手术期强化谷氨酰胺肠外营养对慢性放射性肠损伤患者的影响

发布时间：2018-07-09 17:42

本文选题：慢性放射性肠损伤 + 围手术期处理　；参考：《南京大学》2012年硕士论文

【摘要】：第一部分慢性放射性肠损伤的围手术期营养支持目的：探讨慢性放射性肠损伤(chronic radiation intestinal injury, CRII)患者围手术期营养支持情况。方法：回顾性总结我科2000年1月至2010年12月206位CRII患者的围手术期营养支持情况,采用主观全而评价(subjective global assessment, SGA)系统对CRII营养状况进行评估。结果：206位CRII患者接受手术229例次,86.16%的CRII患者入院时有营养不良。术前营养支持174例次(EN83例次,TPN61例次,EN+PN30例次),术后营养支持共159例次(EN131例次,TPN14例次,EN+PN14例次)。经围手术期营养支持及手术治疗,患者营养状况得到了明显改善,术前营养相关指标除血红蛋白、白蛋白外均较入院时明显增加,出院时白蛋白较术前明显增加,血红蛋白、甘油三酯较术前有所下降,但营养不良发生率仍然较高(57.86%)。结论：CRII患者的营养不良发生率甚高,围手术期营养支持时间较长,围手术期营养支持及手术显著改善其营养状况。第二部分围手术期强化谷氨酰胺肠外营养对放射性肠损伤患者的影响：前瞻、随机、对照研究目的：研究强化谷氨酰胺全肠外营养对慢性放射性肠损伤患者围手术期营养支持效果、免疫功能及肠屏障功能的影响。方法：将40名放射性肠损伤患者随机分为常规肠外营养组(STD组,n=20)；谷氨酰胺组(GLN组,n=20)。分别在术前和术后2周予以常规肠外营养或谷氨酰胺加强的肠外营养。在入院、入院1周、入院2周和术后第3天、1周、2周检测本关血液营养指标、免疫指标、谷氨酰胺血药浓度、体质分析指标、尿中乳果糖/甘露醇(L/M)及SGA评分。结果：入选CRII患者共40例(男性10例,女性30例),随机分为2组(Gln-PN组、PN组),均按计划完成治疗。两组较入院时营养状况、免疫功能及肠道通透性均有显著改善。两组间谷氨酰胺血药浓度在整个围手术期均见显著差异。Gln-PN组术后行肠内营养时间、耐受全量肠内营养时间及术后营养支持时间较PN组有显著差异。同时,实验组SGA评分在术后第2周时较对照组有显著差异(p0.05)。体质分析指标中术后1周实验组BMI较对照组有显著差异,体脂肪在入院2周时实验组较对照组有显著差异。转铁蛋自在入院2周、术后1周,前白蛋白、和甘油三酯在术后第2周有显著差异。免疫功能方而,IgA、IgM在入院1、2周和术后第1、2周均可见显著差异,IgG在入院2周、术后第2周有显著差异,T辅助/T抑制、T辅助诱导细胞比例在入院2周和术后第2周存在显著差异,T抑制杀伤细胞比例在术后第1、2周存在显著差异,T细胞比例在入院2周存在显著差异。肠通透性检测中,,L/M在术后、术后第1周、第2周均见显著差异。结论：谷氨酰胺强化肠外营养较普通肠外营养可更加明显地改善患者营养状况、免疫功能及肠道通透,并增加围手术期血浆谷氨酰胺浓度,加快术后肠功能恢复。
[Abstract]:Part one: perioperative nutritional support for chronic radiation-induced intestinal injury objective: to investigate the perioperative nutritional support in patients with chronic radiation-induced intestinal injury (chronic radiation intestinal injury, CRII). Methods: the nutritional status of 206 patients with CRII from January 2000 to December 2010 was reviewed retrospectively. The nutritional status of the patients was evaluated by subjective total evaluation (subjective global assessment,) system. Results 229 cases (86.16%) of patients with CRII underwent surgery. 86.16% had malnutrition at admission. There were 174 cases of preoperative nutritional support (en 83 times TPN 61 times en PN 30 times) and 159 cases of postoperative nutrition support (en 131 times TPN 14 times en PN 14 times). The nutritional status of the patients was significantly improved by perioperative nutritional support and surgical treatment. In addition to hemoglobin, albumin and albumin were significantly increased before operation, albumin was significantly increased at discharge, hemoglobin, hemoglobin, Triglyceride was lower than that before operation, but the incidence of malnutrition was still higher (57.86%). Conclusion the incidence of malnutrition is very high in the patients with CRII and the time of nutritional support in perioperative period is longer. Nutritional support during perioperative period and operation can significantly improve the nutritional status of the patients. Part two the effect of perioperative enhanced parenteral nutrition on patients with radiation-induced intestinal injury: prospective, randomized, Objective: to study the effects of enhanced total parenteral nutrition (TPN) on nutritional support, immune function and intestinal barrier function in patients with chronic radiation-induced intestinal injury. Methods: forty patients with radiation-induced intestinal injury were randomly divided into routine parenteral nutrition group (STD group) and glutamine group (GLN group). Routine parenteral nutrition or glutamine-enhanced parenteral nutrition were given before and 2 weeks after operation. The blood nutrition index, immune index, glutamine concentration, physique analysis index, lactofructose / mannitol (L / M) in urine and SGA score were measured at admission, 1 week, 2 weeks and 2 weeks after operation. Results: a total of 40 CRII patients (male 10 and female 30) were randomly divided into two groups (Gln-PN group and PN group). The nutritional status, immune function and intestinal permeability were significantly improved in both groups. There was significant difference in serum glutamine concentration between the two groups during the whole perioperative period. The time of enteral nutrition tolerance and postoperative nutritional support time of Gln-PN group were significantly different from those of PN group. At the same time, the SGA score in the experimental group was significantly different from that in the control group at the second week after operation (p0.05). The BMI of the experimental group was significantly higher than that of the control group at 1 week after operation, and the body fat was significantly different from that of the control group at 2 weeks after admission. There was a significant difference between prealbumin and triglyceride at 2 weeks after admission and 1 week after operation. There was a significant difference in IgG between the 1st week of admission and the 1st week after operation, and the difference of IgG between the first week of admission and the first week 2 weeks after operation. There was a significant difference in the ratio of T assisted / T suppression T induced cells at the 2nd week after operation and at the second week after operation. There was a significant difference in the proportion of T suppression killer cells in the first week of operation and the proportion of T cells in the second week after operation. There was a significant difference between the two weeks in the hospital. There were significant differences between L / M and L- M in the first week and the second week after operation. Conclusion: compared with common parenteral nutrition, glutamine enhanced parenteral nutrition can significantly improve the nutritional status, immune function and intestinal permeability, increase plasma glutamine concentration in perioperative period, and accelerate the recovery of postoperative intestinal function.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R818

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