多种油脂肪乳对老年胃肠道肿瘤患者术后的影响

发布时间：2018-04-24 03:01

本文选题：多种油脂肪乳 + 胃肠道肿瘤　；参考：《青岛大学》2017年硕士论文

【摘要】：目的胃肠道肿瘤术后的老年患者,由于其机体处于严重应激状态,因此会造成不同程度的炎症反应及免疫紊乱。此时,若能合理应用以肠外营养为主的术后支持治疗,则对患者术后整体机能的改善和术后良好的恢复具有重要意义。由于脂肪乳是肠外营养中的重要组成部分,因此对脂肪乳的选择就显得至关重要。本文旨在探讨多种油脂肪乳制剂(SMOFlipid-soybean oil,medium chain triglyceride,olive oil,fish oil)对老年胃肠道肿瘤患者术后免疫功能、炎症反应及营养状态的影响。方法将55例胃肠道肿瘤切除术后且NRS2002营养风险评分超过3分需要肠外营养支持至少4d以上的老年患者,按随机对照的原则分为研究组27例和对照组组28例。术后第一天给予以葡萄糖为主要能源的肠外营养,并按所需基本能量的一半,进行补充葡萄糖。由术后第二天起开始连续5d给予患者等氮0.2g/(kg·d)、等热量104.6k J/(kg·d)以葡萄糖和脂肪乳为主要能源的肠外营养支持,其中对照组脂肪乳采用20%中长链混合脂肪乳1.2g/(kg·d)(力能?/Lipovenoes MCT);研究组脂肪乳采用多种油脂肪乳1.2g/(kg·d)(合文?/SMOFlipid?)。分别在术前、术后第1、6天清晨,抽取两组患者的空腹外周静脉血标本。以检测患者的炎症指标:白细胞(WBC)、C反应蛋白(CRP);营养指标:总蛋白(TP)、白蛋白(ALB);肝肾功:谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)、尿素氮(BUN)及免疫指标:淋巴细胞总数(TLC)、淋巴细胞亚群(CD3+、CD4+、CD8+、CD19+)、免疫球蛋白(Ig A、Ig G、Ig M、Ig E)。将两组试验所得数据运用SPSS 19.0统计学软件进行重复测量方差分析。结果对两组患者手术前后的各项免疫指标、炎症指标及营养指标进行检测后,得出如下结果,两组患者的免疫指标:CD3+、CD4+、CD8+、CD19+、Ig A、Ig M、Ig G、TLC;营养指标及肝肾功:TP、ALB、ALT、AST、BUN、Cr;炎性指标:WBC、CRP在手术前后不同时间之间有显著差异(p0.05);两组患者的CD19+、Ig G、TLC、TP在时间与分组之间存在交互效应(p0.05);从各时间点看,两组患者分别在术前及术后第1天各项指标无显著性差异,在术后第6天,研究组患者的免疫功能及炎症反应明显改善,其CD3+、CD4+、Ig G、Ig A、TP水平均显著高于对照组(p0.05),且CRP、WBC明显低于对照组(p0.05)。结论对上述试验结果进行讨论分析可得出以下结论,应用以肠外营养为主的术后支持治疗,对胃肠道肿瘤患者术后免疫功能恢复、炎症状态改善及保护肝肾功能是有益的;此外,研究组患者术后机体功能的恢复较对照组更为显著,因此,将SMOFlipid用于老年胃肠道肿瘤患者术后的营养支持治疗,更有利于抑制由手术创伤所造成的过度炎症反应,并能同时改善机体应激状态下的免疫抑制,提高机体免疫功能,对促进患者术后恢复具有重要意义。
[Abstract]:Objective the elderly patients with gastrointestinal neoplasms after operation are in severe stress state, which may cause inflammatory reaction and immune disorder in varying degrees. At this time, if the postoperative support therapy with parenteral nutrition is used reasonably, it is of great significance to improve the overall function of the patients after operation and to recover well after the operation. Fat milk is an important part of parenteral nutrition, so it is very important to choose fat milk. The purpose of this paper is to investigate the effects of oil chain triglyceride-olive oilfish (SMOFlipid-soybean bean) on postoperative immune function, inflammatory response and nutritional status in elderly patients with gastrointestinal cancer. Methods 55 elderly patients with NRS2002 nutritional risk of more than 3 days after gastrointestinal tumor resection were divided into study group (n = 27) and control group (n = 28) according to the principle of randomized control. On the first day after surgery, glucose was given parenteral nutrition with glucose as the main energy source, and glucose was supplemented with half of the basic energy required. From the second day after operation, the patients were given iso-nitrogen 0.2g/(kg dU and equal calorie 104.6k J/(kg d for 5 consecutive days. The patients received parenteral nutrition with glucose and fat milk as the main energy sources. The control group was treated with 20% medium and long chain mixed fat emulsion 1.2g/(kg dct, and the study group with multiple oil fat emulsions, 1.2g/(kg dai (/ SMOFlipididae), and the control group (n = 10) with different types of fat emulsion, the control group (n = 10) and the control group (n = 20). Fasting peripheral venous blood samples were collected from two groups of patients before and 6 days after operation. In order to detect the inflammatory indexes of the patients: WBCC-reactive protein (CRPU); nutritional index: total protein TPN, Albumin (ALBN); liver and kidney function: alanine aminotransferase (alt), aspartate aminotransferase (ASTT), creatinine (Cr), urea nitrogen bun (BUNA) and immune index: total lymphocyte count (TLCN), lymphocytic count (TLCN), liver and kidney function: alanine aminotransferase (alt). CD3, CD 4, CD 8, CD 19, immunoglobulin I g, G G, Ig MU Ig E. The data of the two groups were analyzed by SPSS 19.0 statistical software. Results after testing the immune, inflammatory and nutritional indexes of the two groups of patients before and after operation, the following results were obtained. The immunological indexes of the two groups were CD3: CD3, CD4, CD8, CD19, Ig, Ig, Ig, TLCc, nutrition, liver and kidney function, and liver and kidney function. The inflammatory index was significantly different between the two groups before and after operation (p 0.05). There was an interaction effect between the time and the grouping of CD19 Ig TLCT in the two groups. From the point of view of each time, On the 6th day after operation, the immune function and inflammatory reaction of the patients in the study group were significantly improved, and there was no significant difference between the two groups before and on the first day after operation. The levels of CD3 CD 4, G G, G G, TP in the control group were significantly higher than those in the control group (P 0. 05), and the levels of CD3 in the control group were significantly lower than those in the control group (P 0. 05). Conclusion the following conclusions can be drawn from the discussion and analysis of the above results: the application of postoperative support therapy with parenteral nutrition is beneficial to the recovery of postoperative immune function, the improvement of inflammatory state and the protection of liver and kidney function in patients with gastrointestinal cancer. In addition, the recovery of body function in the study group was more significant than that in the control group. Therefore, the use of SMOFlipid in postoperative nutritional support therapy for elderly patients with gastrointestinal cancer was more beneficial to the suppression of the excessive inflammatory response caused by surgical trauma. It can also improve the immune suppression and immune function of the patients under stress. It is of great significance to promote the recovery of patients after operation.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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