目的 观察分析胃癌患者术后早期应用免疫增强型肠内营养制剂联合肠外营养的临床疗效及可行性.方法 选择2014年10月至2017年10月河北省邯郸市中心医院120例手术治疗的胃癌患者作为研究对象.按随机数字表法分为早期免疫增强型肠内营养制剂联合肠外营养(EEN+PN)组和全肠外营养(TPN)组,各60例.比较两组患者术后的营养指标[白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb)、转铁蛋白(TRF)]、免疫指标[IgA、IgG、IgM、CD3+、CD4+、CD4+/CD8+]/人体指标[体质量指数(BMI)、上臂肱三头肌皮褶厚度(TSF)、上臂肌围(AMC)、上臂围(AC)]及排气排便时间、经口进流食时间、下床时间、住院时间.结果 两组手术后7 d ALB、PA和TF水平均高于手术前(P<0.05),且EEN+PN组明显高于TPN组(P<0.05).两组手术后7 d Hb水平低于手术前(P<0.05),但EEN+PN组高于TPN组(P<0.05).两组手术后7 d BMI水平均较治疗前显著改善(P<0.05),且EEN+PN组BMI、AC均优于TPN组(P<0.05).术后7 d各免疫功能指标两组均明显改善,且EN+PN组改善的更加明显(P均<0.05).EEN+PN组术后排气排便时间、经口进流食时间、下床时间、住院时间均优于TPN组(P<0.05).结论 胃癌患者术后早期应用免疫增强型肠内营养制剂联合肠外营养优于全肠外营养.

目的 探讨十全大补汤联合肠内营养支持对老年胃癌术后气血两虚证病人营养状况和免疫功能的影响.方法 选取2016年1月至2017年12月邯郸市第一医院老年胃癌手术后气血两虚证病人76例,按照随机数字表法分为观察组38例和对照组38例.对照组给予常规肠内营养支持治疗,观察组在对照组基础上辅助使用中药十全大补汤,给予中西医结合肠内营养支持治疗.经治疗后,比较两组病人肠鸣音恢复时间及排气、排便时间.对比两组病人在治疗前、治疗第8天后病人的营养状况和免疫功能指标的变化情况.结果 观察组在术后肠鸣音恢复时间(41.2±5.2)h及排气(69.5±7.8)h、排便时间(81.5±9.8)h上显著快于对照组(49.5±6.5)h、(73.6±8.6)h、(88.2±10.5)h,差异有统计学意义(P<0.05).治疗8 d后,观察组总蛋白(TP)(64.09±5.07)g·L-1、转铁蛋白(TRF)(2.10±0.18)g·L-1及血红蛋白(Hb)(117.59±14.32)g·L-1上升幅度均显著高于对照组(61.16±5.01)、(1.99±0.19)、(110.45±16.42)g·L-1(P<0.05);观察组血清IgA、IgG、IgM水平升高幅度均显著高于对照组(P<0.05).两组病人治疗8 d后CD4+均升高(P<0.05),但观察组高于对照组(P<0.05);两组病人CD8+均降低(P<0.05),但观察组低于对照组(P<0.05);两组病人CD4+/CD8+均提升(P<0.05),但观察组高于对照组(P<0.05).结论 对于老年胃癌术后气血两虚证病人,运用中西医结合理念,应用十全大补汤联合肠内营养支持不仅可在一定程度上促进肠功能恢复、改善机体营养状况,而且还能提高机体免疫力,起到了促进病人早日康复的目的.

Objective To explore the significance of using enteral nutrition adding glutamine therapy in patients with hyperlipidemic acute pancreatitis.Methods A total of 86 patients with HAP from January 2012 to December 2015 were selected and randomly divided into observation group and control group,each group had 43 cases,all patients were treated with conventional treatment.Patients with bowel function after recovery,two groups were early given enteral nutrition therapy,observation group were received enteral nutrition adding glutamine.Compare two groups of patients before and after 10d treatment of immune status indicators and inflammatory status indicators,and compared two groups of patients with the average length of hospital stay and cost of hospitalization.Results Two groups of patients before treatment no obvious difference was found between the immune status indicators and inflammatory status indicators(P ＞ 0.05).Given different enteral nutrient solution treatment after 10d,the immune status indicators and inflammatory status indicators of observation group droped were better than the control group(P ＜ 0.05),at the same time observation group of patients with the average length of hospital stay and hospital costs were lower than the control group (P ＜ 0.05).Conclusion Enteral nutrition adding glutamine could more effectively improved the immune function of patients with HAP,reduced inflammation reaction,lower health care costs,shorten the hospitalization time,thus improving prognosis and promoting recovery of the patient.

高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HAP)是一种临床常见的急腹症,《急性胰腺炎诊治指南(2014)》中提出早期给予患者进行肠内营养支持(Enteral nutrition,EN),对临床预后意义重大[1].免疫营养组件强化的肠内营养治疗可改善患者营养状况,降低感染风险.同时中药大黄通里攻下,能恢复肠蠕动,治疗急性胰腺炎效果肯定.笔者联合使用免疫型肠内营养及大黄观察临床疗效.