早期肠内营养对胃癌病人术后肠黏膜屏障功能的影响

发布时间：2018-03-21 19:21

本文选题：肠黏膜屏障　切入点：胃癌　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过临床对比术后不同时间给予胃癌病人肠内营养,观察分析肠黏膜屏障的检测指标,探讨早期肠内营养对胃癌病人术后肠黏膜屏障功能的影响。方法:将山西医科大学第一附属医院胃肠外科2015年6月至2016年10月收住院确诊为胃癌并行胃癌根治术的60例病人按随机数字表法分为观察组(早期营养组,n=30)和对照组(非早期营养组,n=30)。早期营养组术后6h后即给予肠内营养,非早期营养组术后48h后给予肠内营养。分别检测病人术前1d、术后1d、4d和7d外周静脉血中反映肠黏膜屏障功能的指标:血浆内毒素(ET)、二胺氧化酶(DAO)、D-乳酸(D-Lac)水平,并记录术后出现切口感染、肺部感染、尿路感染、腹腔脓肿等感染并发症的发生例数。结果:早期营养组、非早期营养组两组术前的各项检测指标均无明显差异(P0.05)。术后1d两组的血浆ET、DAO、D-lac比术前明显升高,与术前1d相比均存在明显差异(P0.05);术后4d、7d两组的指标均有不同程度的下降,总体水平高于术前,差异具有统计学意义(P0.05);两组术后1d的各项指标相比无统计学意义(P0.05),术后4d、7d的各项指标早期营养组均比非早期营养组低,差异具有统计学意义(P0.05);术后早期营养组的病人出现的感染并发症例数比非早期营养组的少,差异有统计学意义(P0.05)。结论:胃癌病人术后肠黏膜屏障功能的指标(血浆DAO、D-Lac、ET)均明显升高,说明手术后早期病人的肠黏膜受到损害;胃癌术后给予早期肠内营养,病人均可耐受,早期营养组能够明显改善肠黏膜屏障功能;早期营养组比非早期营养组出现的感染并发症少,维持肠黏膜的完整性,改善预后。
[Abstract]:Objective: to observe and analyze the detection index of intestinal mucosal barrier by clinical comparison of enteral nutrition in patients with gastric cancer at different time after operation. To investigate the effect of early enteral nutrition on intestinal mucosal barrier function in patients with gastric cancer after operation. Methods: from June 2015 to October 2016, gastrointestinal surgery in the first affiliated Hospital of Shanxi Medical University was admitted to hospital and diagnosed as gastric cancer with radical gastrectomy. Sixty patients were randomly divided into observation group (early nutrition group, n = 30) and control group (control group, n = 30). Early nutrition group was given enteral nutrition 6 hours after operation. In the non-early nutrition group, enteral nutrition was given 48 hours after operation. The levels of plasma endotoxin and D-lactamide were measured in peripheral venous blood of the patients 1 day before operation, 1 day after operation and 7 days after operation. Postoperative complications such as incision infection, pulmonary infection, urinary tract infection and abdominal abscess were recorded. There was no significant difference between the two groups in each index before operation (P 0.05). The plasma ETDAO D-lac in the two groups was significantly higher than that before operation on the 1st day after operation, and there was a significant difference between the two groups on the 1st day after operation (P 0.05), and on the 4th day after operation, the indexes of the two groups were decreased in varying degrees. The total level was higher than that before operation, the difference was statistically significant (P 0.05), the indexes of the two groups on the 1st day after operation had no statistical significance (P 0.05), and the indexes of the early nutrition group on the 4th day after operation were lower than those of the non-early nutrition group. The difference was statistically significant (P 0.05). The number of infection complications in the early nutrition group was less than that in the non-early nutrition group. Conclusion: the indexes of intestinal mucosal barrier function (plasma DAOOD-Lactein et) in patients with gastric cancer increased significantly after operation, indicating that the intestinal mucosa was damaged in the early stage after operation, and that the patients could tolerate early enteral nutrition after gastric cancer operation. The early nutrition group can obviously improve the intestinal mucosal barrier function, and the early nutrition group has fewer infection complications than the non-early nutrition group, which can maintain the integrity of intestinal mucosa and improve the prognosis.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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