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肝胆手术后肠内营养与肠外营养支持对患者炎性因子与免疫学指标的影响.doc

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肝胆手术后肠内营养与肠外营养支持对患者炎性因子与免疫学指标的影响.doc
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(EN) (PN) 2012 1 -2016 6 196 ; EN 102 , PN 94 1d 7d 7d, 1d , EN PN [TNF- -6: - 0.05) EN PN ; ; ; ; ; ; (1969-) , , , , , Effects on inflammatory factors and immune indexes between enteral nutrition and parenteral nutrition support in hepatobiliary surgery patients Yang Conglian Guan Suling Wang Jun Liu Xinhui Chen Shenggui Department of Hepatology.The Combine Traditional Chinese and Western Medicine Hospital; Abstract Objective To compare the effects on variations of peripheral inflammatory factor and immunological indexes between enteral nutrition (EN) and parenteral nutrition (PN) support in hepatobiliary surgery patients.Methods A retrospective analysis was conducted among 196 cases underwent pancreaticoduodenectomy and liver resection from January 2012 to June 2016, of which 102 cases with postoperative EN support, and 94 cases with PN support.Variations of postoperative peripheral blood inflammatory factors and immune indexes, as well as the occurrences of complications was measured and compared between the two groups 1 dand 7 dafter surgery.Results The seventh days after operation, the peripheral blood inflammatory factors decreased for both two groups compared with that of postoperative 1 d, the decrease in EN group was significantly higher than that of the PN group[TNF- IL- - CD4+/CD8+7 dpost-operation increased for two group compared with postoperative 1 d, The increase in EN group was significantly higher than all P0.05) .Conclusion Hepatobiliary surgery patients underwent EN postoperative support is advantageous in reducing inflammatory stress, improving immune suppression and reducing complications compared with PN support. Keyword Enteral nutrition; Parenteral nutrition; Inflammatory stress; Immune; Hepatobiliary surgery; Nursing; , , , , , [1] [2] : (Enteral nutrition, EN) (Parenteral nutrition, PN) , , EN PN , 1 1.1 : (1) 0.05) , 1 1 1.2 1.2.1 EN , 15cm 24h , 500mL; , 250mL , 3h, 250mL ; 2 1 000mL , 3h 3 ; 3 1 500mL 8~10d, 1.2.2 PN PN , { ( 60%) ( 40%) [ ( ) }, 24h PN , 1 1/3 2 2/3 3 , 8~10d, 1.3 1 7 , (IgA IgG IgM) , T (CD3% CD4%/CD8%) ; ELISA (TNF- IL-6 IL-8) , C (CRP) , 1.4 Microsoft-EXCEL , SPSS 19.0 , , t , fisher 2 2.1 7 , 1 , EN PN (P0.05) 4 4 3 , , , , ; [4], SIRS , , , EN PN , PN , ; PN , [5] EN , [6], [7] , TNF- IL-6 IL-8 CRP ; , , , SIRS [8] , , T CD3 CD4 CD4/CD8 [9], , , [10] , , , , [11] , CD3 T , CD4/CD8 , ( 1.2~2.0) , , [12] , B , B IgA IgG IgM , [13] , 7 1 , IgA IgG IgM CD3 CD4/CD8 1 , EN PN ;EN CD3 CD4/CD8 PN , EN PN [14] , , , :PN EN , EN PN , , [15] , 2~3h , 12~24h EN , , , , , [16] PN , , , [17] EN PN , PN EN , , PN EN PN EN , , [18-19] , , EN PN , EN [1]Cai C, Cao Z, Loughran P A, et al.Mast cells play a critical role in the systemic inflammatory response and end-organ injury resulting from trauma[J].J Am Coll Surg, 2011, 213 (5) :604-615. [2] , , , . [J]. , 2010, 16 (8) :604-607. [3] , . : (ASPEN) 2011 [J]. , 2012, 20 (5) :261-268. [4]Yang D, He W, Zhang S, et al.Fast-track surgery improves postoperative clinical recovery and immunity after elective surgery for colorectal carcinoma:randomized controlled clinical trial[J].World J Surg, 2012, 36 (8) :1874-1880. [5] , , , . [J]. , 2015, 37 (1) :102-104. [6] .Nutrition in pancreatic cancer:A review[J].Gastroint-est Tumors, 2016, 2 (4) :195-202. [7] , . [J]. , 2012, 18 (9) :656-658. [8]Marano L, Porfidia R, Pezzella M, et al.Clinical and immunological impact of early postoperati-ve enteral immunonutrition after total gastrectomy in gastric cancer patients:aprospective randomized study[J].Ann Surg Oncol, 2013, 20 (12) :3912-3918. [9]Suzuki D, Furukawa K, Kimura F, et al.Effects of perioperative immunonutrition on cell-mediated immunity, T helper type 1 (Th1) /Th2differentiation, and Th17response after pancreaticoduodenectomy[J].Surgery, 2010, 148 (3) :573-581. [10]Veenhof A A, Vlug M S, van der Pas M H, et al.Surgical stress response and postoperative immune function after laparoscopy or open surgery with fasttrack or standard perioperative care:a randomized trial[J].Ann Surg, 2012, 255 (2) :216-221. [11]Sunpaweravong S, Puttawibul P, Ruangsin S, et al.Randomized study of antiinflammatory and immune-modulatory effects of enteral immunonutrition during concurrent chemoradiotherapy for esophageal cancer[J].Nutr Cancer, 2014, 66 (1) :1-5. [12] , , , . [J]. , 2014, 9 (2) :135-138. [13]Uno H, Furukawa K, Suzuki D, et al.Immunonutrition suppresses acute inflammatory responses through modulation of resolvin E1in patients undergoing major hepatobiliary resection[J].Surgery, 2016, 160 (1) :228-236. [14] , , , . [J]. , 2015, 8 (1) :145-147. [15]Park J S, Chung H K, Hwang H K, et al.Postoperative nutritional effects of early enteral feeding compared with total parental nutrition inpancreaticoduodectomy patients:aprosepective, randomized study[J].J Korean Med ScI, 2012, 27 (3) :261-267. [16]Ciacio O, Voron T, Pittau G, et al.Interest of preoperative immunonutrition in liver resection for cancer:study protocol of the PROPILS trial, a multicenter randomized controlled phase IV trial[J].BMC Cancer, 2014, 14:980. [17]Zhu X H, Wu Y F, Qiu Y D, et al.Effect of early enteral combined with parenteral nutrition in patients undergoing pancreaticoduodenectomy[J].World J Gastroenterol, 2013, 19 (35) :5889-5896. [18] , , , . [J]. , 2016, 36 (1) :375-377. [19] , , , . [J]. , 2015, 23 (3) :192-194.
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本文标题:肝胆手术后肠内营养与肠外营养支持对患者炎性因子与免疫学指标的影响.doc
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