早期肠内免疫微生态营养对原发性肝癌患者术后临床疗效的影响

doi:10.3969/j.issn.1672-5069.2017.03.018

摘要/Abstract

摘要： 目的观察原发性肝癌患者行肝癌切除术后早期给予肠内免疫微生态营养支持的临床疗效。方法 120例行原发性肝癌切除术患者被随机分为观察组60例和对照组60例,对照组术后常规肠内营养,观察组在对照组的基础上在肠内营养物中加入L-谷氨酰胺、L-精氨酸和双歧三联活菌,比较两组患者术后肝功能、凝血功能、血清免疫球蛋白、内毒素、肿瘤坏死因子α（TNF-α）、白介素6 （IL-6）、外周血CD4⁺和CD8⁺淋巴细胞、一般状况和胃肠道功能。结果观察组患者术后第7天血清白蛋白、前白蛋白、血清IgA、IgG、IgM、血CD4⁺和CD8⁺淋巴细胞相对计数分别为（41.65±4.58） g/L、（196.65±25.64） mg/L、（2.12±0.56） g/L、（9.65±0.86） g/L、（0.98±0.25） g/L、（0.42±0.14）和（0.32±0.05）,均显著高于对照组的[（35.52±5.38） g/L、（178.38±30.54） mg/L、（1.83±0.48） g/L、（8.22±0.68） g/L、（0.80±0.25） g/L、（0.32±0.06）和（0.24±0.08）,P均<0.05];国际标准化比值、总胆红素、直接胆红素、内毒素、TNF-α和IL-6分别为（1.05±0.16）、（20.34±8.65）μmol、（11.35±2.38）μmol/L、（1.82±0.25）ng/L、（258.62±28.65） pg/mL和（156.24±9.38） pg/mL,均显著低于对照组的[（1.46±0.18）、（38.65±9.46）μmol、（19.35±4.28）μmol/L、（2.14±0.15） ng/L、（314.65±41.28） pg/mL和（171.35±20.38） pg/mL,P均<0.05];观察组患者术后排气、排便、下床活动、进食半流质、住院时间分别为（44.52±8.36）h、（74.35±14.68）h、（30.17±9.65）h、（85.34±16.25）h和（10.25±1.88） d,均显著短于对照组的[（68.65±10.48） h、（112.58±14.95） h、（41.35±10.38）h、（115.36±25.68）h、（14.58±2.36） d,P均<0.01]。结论在原发性肝癌肝切除术后早期给予肠内免疫微生态营养支持有助于改善患者营养状态,提高免疫功能,减轻炎症反应和肝功能损害,促进患者早期康复。

关键词: 肝癌, 肝切除术, 肠内营养, 免疫微生态营养, 临床疗效

Abstract: Objective To observe the clinical effects of early enteral nutrition and ecoimmunonutrition in patients with primary liver cancer after hepatectomy. Methods 120 patients with primary liver cancer after hepatectomy were randomly divided into observation group （n=60） and control group （n=60）. In the control group, the patients were treated with routine enteral nutrition,while in the observation group the intervention including L-glutamine,L-arginine and bifid triple viable were given at the base of routine enteral nutrition. The postoperative serum liver function index,immunoglobulin,endotoxin,tumor necrosis factor alpha （TNF-α）,interleukin 6（IL-6）,peripheral blood CD4⁺ and CD8⁺ lymphocytes,general condition and gastrointestinal function were compared between the two groups. Results The levels of serum albumin,prealbumin,IgA,IgG,IgM,blood CD4⁺ and CD8⁺ in the observation group on the 7th postoperative day were （41.65±4.58） g/L,（196.65±25.64） mg/L,（2.12±0.56） g/L,（9.65±0.86） g/L,（0.98±0.25） g/L,（0.42±0.14） and（0.32±0.05）,much higher than those in the control group [（35.52±5.38） g/L and （178.38±30.54） mg/L,（1.83±0.48） g/L,（8.22±0.68） g/L,（0.80±0.25） g/L,（0.32±0.06） and（0.24±0.08）,P<0.05],while the levels of international normalized ratio,total bilirubin,direct bilirubin,endotoxin, TNF-α and IL-6 in the observation group were（1.05±0.16）,20.34±8.65） μmol,（11.35±2.38） μmol/L,（1.82 ± 0.25） ng/L,（258.62±28.65） pg/mL and （156.24±9.38） pg/mL,much lower than those in the control group [（1.46 ± 0.18）,（38.65±9.46） μmol,（19.35 ±4.28） μmol/L,（2.14±0.15） ng/L,（314.65±41.28） pg/mL and （171.35±20.38） pg/mL,P<0.05];the time of postoperative exhaust,defecation,ambulation,semifluid diet and hospitalization in the observation group were [（44.52±8.36） h,（74.35 ±14.68） h,（30.17±9.65） h,（85.34±16.25） h,and （10.25±1.88） d,significantly shorter than those in the control group [（68.65±10.48） h,（112.58±14.95） h,（41.35±10.38） h,（115.36±25.68） h,（14.58±2.36） d,P<0.05]. Conclusion Early enteral nutrition and ecoimmunonutrition can improve the nutritional status,improve immune function,reduce inflammation and liver damage,and promote early rehabilitation of patients with primary liver cancer after hepatectomy.

Key words: Hepatoma, Hepatectomy, Enteral nutrition, Ecoimmunonutrition, Clinical effect

雍伟. 早期肠内免疫微生态营养对原发性肝癌患者术后临床疗效的影响[J]. 实用肝脏病杂志, 2017, 20(3): 328-332.

Yong Wei. Early enteral nutrition and ecoimmunonutrition in patients with primary liver cancer after hepatectomy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(3): 328-332.

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