作者：庞士静，黄桂荣，丁世陆

单位：皖西卫生职业学院附属医院六安市第二人民医院 普外科，安徽 六安 237000

Authors: Pang Shijing，Huang Guirong，Ding Shilu

Unit: Department of General Surgery, The Second People's Hospital of Lu'an City, Affiliated Hospital of West Anhui Health Vocational College, Lu'an 237000, Anhui, China

摘要：

目的 探讨动态调整肠内营养泵在食管癌根治术后肠内营养中的应用效果。方法 选取皖西卫生职业学院附属医院六安市第二人民医院2018年1月至2021年5月收治的食管癌根治术后需要肠内营养的患者120例，将患者以数字随机法分为观察组与对照组，观察组64例，对照组56例，对照组采用传统肠内营养泵进行干预，观察组采用动态调整肠内营养泵干预。两组患者术前、术后3个月后采血测定总蛋白、白蛋白、前白蛋白、转铁蛋白水平；采用酶联免疫吸附测定法(ELISA)测定炎性反应指标：C-反应蛋白(CRP)、白介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)水平；采用流式细胞仪检测T细胞亚群成熟T淋巴细胞(CD3+)、诱导性T细胞(CD4+)、抑制性T细胞(CD8+)、CD4+/CD8+变化；采用患者参与的主观全面评定(PG-SGA)评估患者的营养状况。观察两组患者的不良反应。结果 干预后观察组患者总蛋白、白蛋白、前白蛋白、转铁蛋白高于对照组(P<0.05)；干预后观察组患者CRP、IL-6、TNF-α低于对照组(P<0.05)；干预后观察组CD3+、CD4+、CD4+/CD8+高于对照组，CD8+低于对照组(P<0.05)；观察组患者轻度营养不良(46.87%)、良好(29.68%)高于对照组(26.78%、14.28%)，中度营养不良(15.62%)、重度营养不良(7.81%)低于对照组(35.71%、23.21%)(P<0.05)；观察组患者总不良反应发生率(3.12%)低于对照组(14.28%)(P<0.05)。结论 通过动态调整肠内营养泵干预，可改善食管癌根治术后患者营养指标，降低术后炎性反应程度，同时还改善患者体内T细胞亚群紊乱，有助于改善营养不良状态，减少患者的不良反应的发生。

关键词：肠内营养泵；食管癌根治术；肠内营养；免疫功能

Abstract：

Objective To explore the application effect of dynamic adjustment of enteral nutrition pump in the enteral nutrition after radical resection of esophageal cancer. Method 120 patients who needed enteral nutrition after radical resection of esophageal cancer admitted to the hospital were selected between January 2018 and May 2021, and they were divided into observation group（64 cases ）and control group（56 cases） according to the random number table method. The control group was given traditional enteral nutrition pump intervention, and the observation group received dynamic adjustment of enteral nutrition pump intervention. The blood samples of the two groups of patients were collected before surgery and at 3 months after surgery to determine the levels of total protein （TP）, albumin （ALB）, prealbumin （PAB） and transferrin（TRF）. Enzyme-linked immunosorbent assay （ELISA） was used to measure the levels of inflammatory response indicators, including C-reactive protein （CRP）, interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α）. Flow cytometry was applied to detect the changes in T cell subsets of mature T lymphocytes （CD3+）, inducible T cells （CD4 + ）, suppressor T cells （CD8 + ） and CD4 +/CD8 +. Patient-generated subjective global assessment（PG -SGA） was adopted to assess the nutrition status of patients. The adverse reactions of the two groups were observed. Result After intervention, the levels of total protein, albumin, prealbumin and transferrin of observation group were higher than those of control group （P<0.05）. The levels of CRP, IL-6 and TNF-α of observation group after intervention were lower than those of control group （P<0.05 ）. After intervention, the levels of CD3 + , CD4 + and CD4 +/CD8 + were significantly higher in observation group than those in control group while the level of CD8+ was lower than that in control group （P<0.05）. The proportions of mild malnu[1]trition and good nutrition with 46.87% and 29.68% in observation group were higher than 26.78% and 14.28% in control group, while the proportions of moderate malnutrition and severe malnutrition with 15.62% and 7.81% were lower than 35.71% and 23.21% in control group （P<0.05 ）. The total incidence rate of adverse reactions of 3.12% in observation group was lower than 14.28% in control group （P<0.05）. Conclusion Dynamic adjustment of enteral nutrition pump intervention can improve the nutritional indicators of patients after radical resection of esophageal cancer, reduce the postoperative inflammatory response, improve the disorder of T cell subsets, and help to improve the malnutrition status and reduce the occurrence of adverse reactions.

Key Words: Enteral nutrition pump；Radical resection of esophageal cancer；Enteral nutrition;Inflammatory response；Immune function