作者：张晓云1，陈螣1，孙京1，刘金英2

单位：1.北京市垂杨柳医院 临床营养科，北京 100022； 2.中国医学科学院肿瘤医院 营养科，北京 100021

Authors:  ZHANG Xiaoyun1, CHEN Teng1, SUN Jing1, LIU Jinying2

Unit:  1.Department of Clinical Nutrition, ChuiYangLiu Hospital, Beijing 100022, China; 2.Department of Nutrition, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China

摘要：

目的   探讨食管癌(EC)术后营养支持时机选择对患者机体营养状况和胃肠粘膜功能的影响。方法  选取我院自2018年2月～2019年2月间收治的行食管癌根治术治疗的患者90例作为实验对象,按照随机分成两组,观察组45例于术后24 h内进行肠内营养支持,对照组于术后24-72 h间行肠内营养支持,对比两组患者干预后胃肠道功能恢复、肠道菌群、营养状况和免疫功能情况。结果  观察组患者术后肛门首次排气时间、排便时间以及肠鸣音恢复时间均明显短于对照组(P<0.05);干预后两组患者血清白蛋白(Alb)、转铁蛋白(TF)以及前白蛋白(PA)均显著高于对照组(P<0.05)。相较术前,术后两组患者肠道屏障功能均明显受损,干预1周后观察组内毒素(ET)、D乳酸(D-Lac)指标降幅优于对照组(P<0.05);干预前组间CD3+、CD4+、CD8+和CD4+/CD8+水平无显著差异,干预后观察组CD3+、CD4+和CD4+/CD8+显著高于对照组,CD8+低于对照组(P<0.05)。结论  EC患者术后早期肠内营养支持可更好的提升机体免疫能力、肠道粘膜屏障功能,改善营养状况,降低并发症风险。

关键词： 食管癌; 肠内营养支持; 免疫功能; 营养状况

Abstract：

Objective  To investigate the effect of timing of nutritional support after esophageal cancer (EC) on the nutritional status and gastrointestinal mucosal function of patients. Methods Ninety patients who underwent radical esophageal cancer treatment from February 2018 to February 2019 in our hospital were enrolled as subjects. They were divided into two groups according to the principle of numerical randomization. 45 patients in the observation group were performed within 24 hours after surgery. Enteral nutrition support was given. The control group received enteral nutrition support 24 to 72 hours after operation. The gastrointestinal function recovery, intestinal flora, nutritional status and immune function were compared between the two groups. Results  The first time of anal exhaust, defecation time and recovery time of bowel sounds in the observation group were significantly shorter than those in the control group (P<0.05). Serum albumin (Alb)and transferrin (TF) were observed in the two groups after intervention. And prealbumin (PA)were significantly higher than the control group (P<0.05). Compared with preoperative and postoperative, the intestinal barrier function of the two groups was significantly impaired. After 1 week of intervention, the levels of endotoxin (ET) and D-Lac (D-Lac) in the observation group were lower than those in the control group (P<0.05). There were no significant differences in CD3+, CD4+, CD8+ and CD4+/CD8+ levels between the pre-intervention groups. After intervention, the CD3+, CD4+ and CD4+/CD8+levels were significantly higher in the observation group than in the control group, and CD8+ was lower than the control group (P<0.05). Conclusions EC patients Early postoperative enteral nutrition support can better improve the body's immunity, intestinal mucosal barrier function, improve nutritional status, and reduce the risk of complications.

Key Words:  Esophageal cancer; Enteral nutrition support; Immune function; Nutritional status