胃癌患者术后早期经口肠内营养的临床研究
发布时间：2018-11-25 20:56
【摘要】：目的研究胃癌患者术后早期经口进食肠内营养制剂的安全性及其对患者短期临床结局、营养状态、免疫功能和应激水平的影响。方法选取青岛大学附属医院普外科2015.7-2016.10收治胃癌患者90例,通过随机数字表法分为试验组45例和对照组45例。最后参与到研究中试验组患者38例,对照组患者42例,总共80例。试验组患者术后早期经口进食水和肠内营养制剂,对照组患者采用术后常规围手术期治疗方案;记录两组患者术后的发热时间、排气时间、住院时间、住院费用等比较短期临床结局;记录两组患者术前1天及术后1、3、7天血清白蛋白、前白蛋白、视黄醇结合蛋白比较营养状态;记录两组患者术前1天及术后1、3、7天CD4+T、CD4+T/CD8+T、Ig G、Ig M、Ig A比免疫功能;记录术前1天及术后1、3、7天CRP、IL-6、Tnf-α比较应激水平;记录试验组术后第2到第6天早期经口肠内营养完成率。结果两组患者相比较,试验组的术后发热时间[(74.63±7.56)h比(80.33±8.57)h,P0.05]、排气时间[(75.24±6.17)h比(80.74±8.58)h,P0.05]、术后住院时间[(8.24±2.46)d比(9.5±1.66)d,P0.05]比对照组短,住院费用[(58.18±5)千元比(63.04±4.36)千元,P0.05]明显减少。试验组与对照组的并发症发生率对比无明显差异[13.2%(5/38)比16.7%(7/42),PO.05];试验组患者术前1天及术后第1、3天血清白蛋白与对照组无明显差异(P0.05),试验组患者术后第7天血清白蛋白高于对照组(P0.05)。试验组患者术前1天及术后第1天血清前白蛋白及视黄醇结合蛋白与对照组无明显差异(P0.05),试验组术后第3天及第7天的血清前白蛋白和视黄醇结合蛋白高于对照组(P0.05);试验组患者术前1天及术后第1、3天CD4+T与对照组无明显差异(P0.05),试验组患者术后第7天的CD4+T高于对照组(P0.05)。试验组患者术前1天及术后第1天CD4+T/CD8+T与对照组无明显差异(P0.05),试验组患者术后第3天和第7天的CD4+T/CD8+T高于对照组(P0.05);试验组患者术前1天及术后第1天Ig G、Ig M、Ig A与对照组无明显差异(均P0.05),试验组患者术后第3天和第7天的Ig G、Ig M、Ig A高于对照组(均P0.05);试验组患者术前1天及术后第1天CRP、IL-6、Tnf-α与对照组无明显差异(均P0.05),试验组患者术后第3天和第7天的CRP、IL-6、Tnf-α均低于对照组(均P0.05)。试验组内第2到6天经口服用肠内营养制剂完成率逐渐增加。结论胃癌患者术后早期经口进食肠内营养制剂是安全的,能够改善患者营养状态、免疫功能,降低应激水平,改善胃癌患者术后的短期临床结局。
[Abstract]:Objective to study the safety of enteral nutrition in early postoperative gastric cancer patients and its effect on the short-term clinical outcome, nutritional status, immune function and stress level. Methods 90 patients with gastric cancer were randomly divided into trial group (n = 45) and control group (n = 45). Finally, there were 38 patients in the trial group and 42 patients in the control group. The patients in the trial group received oral water and enteral nutrition early after operation, while the patients in the control group were treated with routine perioperative treatment. The postoperative fever time, exhaust time, hospitalization cost and so on were recorded in the two groups. The nutritional status of serum albumin, prealbumin and retinol binding protein were recorded 1 day before operation and 1 day after operation. The specific immunological function of CD4 T 4, T/CD8, Ig, Ig and Ig A were recorded 1 day before operation and 1 day and 3 days after operation, and the stress levels of CRP,IL-6,Tnf- 伪 were recorded 1 day before operation and 1 day after operation, 3 days after operation, 1 day before operation and 1 day after operation. The rate of early oral enteral nutrition in the trial group was recorded 2 to 6 days after operation. Results the postoperative fever time was (74.63 卤7.56) h vs (80.33 卤8.57) h, the exhaust time was (75.24 卤6.17) h vs (80.74 卤8.58) h in the experimental group. The postoperative hospitalization time [(8.24 卤2.46) days vs (9.5 卤1.66) d] was shorter than that of the control group [(58.18 卤5) thousand yuan vs (63.04 卤4.36) thousand yuan, P0.05]. There was no significant difference in the incidence of complications between the trial group and the control group [13.2% (5 / 38) vs 16.7% (7 / 42), PO.05]; There was no significant difference in serum albumin between the test group and the control group on the 1st day before operation and the 1st day after operation (P0.05). The serum albumin in the test group was higher than that in the control group on the 7th day after operation (P0.05). There was no significant difference in serum prealbumin and retinol binding protein between the test group and the control group 1 day before and 1 day after operation (P0.05). The levels of serum prealbumin and retinol binding protein in the experimental group were higher than those in the control group on the 3rd and 7th day after operation (P0.05). There was no significant difference in CD4 T between the test group and the control group 1 day before operation and 1 day after operation (P0.05). The CD4 T of the test group was higher than that of the control group on the 7th day after operation (P0.05). There was no significant difference in CD4 T/CD8 T between the test group and the control group on the first day before operation and on the first day after operation (P0.05). The CD4 T/CD8 T of the trial group was higher than that of the control group on the 3rd and 7th day after operation (P0.05). There was no significant difference between the patients of the trial group and the control group on the first day before operation and on the first day after operation (P0.05), and the Ig GG Ig A of the patients in the trial group was higher than that of the control group on the 3rd and 7th day after operation (P0.05). There was no significant difference in CRP,IL-6,Tnf- 伪 between the test group and the control group on the first day before operation and on the first day after operation (P0.05). The CRP,IL-6,Tnf- 伪 of the test group was lower than that of the control group on the 3rd and 7th day after operation (P0.05). The completion rate of oral enteral nutrition in the trial group increased gradually from day 2 to day 6. Conclusion it is safe for gastric cancer patients to take enteral nutrition preparation early after operation, which can improve the nutritional status, immune function, reduce stress level and improve the short-term clinical outcome of gastric cancer patients.
【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】：R735.2
本文编号：2357348
[Abstract]:Objective to study the safety of enteral nutrition in early postoperative gastric cancer patients and its effect on the short-term clinical outcome, nutritional status, immune function and stress level. Methods 90 patients with gastric cancer were randomly divided into trial group (n = 45) and control group (n = 45). Finally, there were 38 patients in the trial group and 42 patients in the control group. The patients in the trial group received oral water and enteral nutrition early after operation, while the patients in the control group were treated with routine perioperative treatment. The postoperative fever time, exhaust time, hospitalization cost and so on were recorded in the two groups. The nutritional status of serum albumin, prealbumin and retinol binding protein were recorded 1 day before operation and 1 day after operation. The specific immunological function of CD4 T 4, T/CD8, Ig, Ig and Ig A were recorded 1 day before operation and 1 day and 3 days after operation, and the stress levels of CRP,IL-6,Tnf- 伪 were recorded 1 day before operation and 1 day after operation, 3 days after operation, 1 day before operation and 1 day after operation. The rate of early oral enteral nutrition in the trial group was recorded 2 to 6 days after operation. Results the postoperative fever time was (74.63 卤7.56) h vs (80.33 卤8.57) h, the exhaust time was (75.24 卤6.17) h vs (80.74 卤8.58) h in the experimental group. The postoperative hospitalization time [(8.24 卤2.46) days vs (9.5 卤1.66) d] was shorter than that of the control group [(58.18 卤5) thousand yuan vs (63.04 卤4.36) thousand yuan, P0.05]. There was no significant difference in the incidence of complications between the trial group and the control group [13.2% (5 / 38) vs 16.7% (7 / 42), PO.05]; There was no significant difference in serum albumin between the test group and the control group on the 1st day before operation and the 1st day after operation (P0.05). The serum albumin in the test group was higher than that in the control group on the 7th day after operation (P0.05). There was no significant difference in serum prealbumin and retinol binding protein between the test group and the control group 1 day before and 1 day after operation (P0.05). The levels of serum prealbumin and retinol binding protein in the experimental group were higher than those in the control group on the 3rd and 7th day after operation (P0.05). There was no significant difference in CD4 T between the test group and the control group 1 day before operation and 1 day after operation (P0.05). The CD4 T of the test group was higher than that of the control group on the 7th day after operation (P0.05). There was no significant difference in CD4 T/CD8 T between the test group and the control group on the first day before operation and on the first day after operation (P0.05). The CD4 T/CD8 T of the trial group was higher than that of the control group on the 3rd and 7th day after operation (P0.05). There was no significant difference between the patients of the trial group and the control group on the first day before operation and on the first day after operation (P0.05), and the Ig GG Ig A of the patients in the trial group was higher than that of the control group on the 3rd and 7th day after operation (P0.05). There was no significant difference in CRP,IL-6,Tnf- 伪 between the test group and the control group on the first day before operation and on the first day after operation (P0.05). The CRP,IL-6,Tnf- 伪 of the test group was lower than that of the control group on the 3rd and 7th day after operation (P0.05). The completion rate of oral enteral nutrition in the trial group increased gradually from day 2 to day 6. Conclusion it is safe for gastric cancer patients to take enteral nutrition preparation early after operation, which can improve the nutritional status, immune function, reduce stress level and improve the short-term clinical outcome of gastric cancer patients.
【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】：R735.2
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