谷氨酰胺肠内营养对老年消化道肿瘤患者免疫指标及术后胃肠功能恢复的影响

纪元++王玮

【摘要】目的探讨谷氨酰胺肠内营养对老年消化道肿瘤患者免疫指标及术后胃肠功能恢复的影响。方法收集老年消化道恶性肿瘤患者120例，根据随机数字表将患者分为两组，对照组60例，采用常规的肠内营养方法；观察组60例，在对照组基础上加谷氨酰胺肠内营养支持，观察两组患者术前、术后第1天、术后第9天时人血白蛋白（ALB）、肿瘤坏死因子（TNF）α、CD3+、CD4+、CD8+、CD4+/CD8+及IgG、IgA、IgM 抗体变化情况。同时观察两组患者术后胃肠功能恢复情况。结果术后第1天，ALB较术前明显降低，TNFα水平较术前明显升高，但两组比较差异无统计学意义（P>0.05），术后第9天两组ALB均回升，但观察组回升程度明显高于对照组（P<0.01）；术后第9天两组TNFα水平较术后第1天均下降，但观察组下降程度明显大于对照组（P<0.01）。术后第9天两组CD3+较术后第1天明显升高（P<0.05）；两组CD4+在术后第1天较术前明显降低，术后第9天较术后第1天明显升高，且观察组升高更明显（P<0.01）；术后第1天，两组CD8+较术前明显升高，术后第9天明显下降，但观察组下降更明显（P<0.01）。术后第9天时，观察组CD4+/CD8+值明显高于对照组（P<0.01），术后第1天较术前明显下降（P<001），术后第9天回升（P<001）。观察组患者IgA术后第1天与对照组比较差异无统计学意义（P>0.05），术后第9天时明显高于对照组（P<0.01）。两组IgG、IgM在术后第1天、术后第9天比较差异无统计学意义（P>0.05）。观察组的腹胀不适发生率明显低于对照组（P<0.01），首次肛门排气时间、肠蠕动恢复时间较对照组明显缩短（P<0.01）。结论谷氨酰胺肠内营养可有效纠正老年消化道肿瘤患者的营养不良和应激状态，提高机体细胞免疫功能和体液免疫功能，促进术后胃肠功能恢复。

【关键词】谷氨酰胺；肠内营养；消化道肿瘤；免疫指标；胃肠功能

中图分类号：R735文献标识码：ADOI：10.3969/j.issn.10031383.2015.06.012

Effects on the immune parameters and postoperative recovery of gastrointestinal function

by glutamine enteral nutrition in senile patients with digestive tract tumor

JI Yuan，WANG Wei

（Southern Institute District of Weihai Municipal Hospital，Weihai 264200，Shandong，China）

【Abstract】ObjectiveTo investigate the effect on the immune parameters and postoperative recovery of gastrointestinal function by glutamine enteral nutrition in senile patients with digestive tract tumor.Methods120 senile patients with malignant digestive tract tumor were collected and randomly divided into observation group and control group with 60 cases in each group.The control group were given conventional enteral nutrition，and the observation group was added glutamine on basis of the control group.Then，changes of serum albumin（ALB），tumor necrosis factor（TNF）α，CD3+，CD4+，CD8+，CD4+/CD8+ and IgG，IgA，IgM before operation，at the first day and ninth day after operation were observed in the two groups.The recovery of gastrointestinal function in the two groups was observed at the same time.Results At the first day after operation，compared with those before operation，the serum ALB significantly decreased，TNFα significantly increased，but difference was not statistically significant （P>0.05）.At the ninth day after operation，compared with those at the first day after operation，ALB of the two groups significantly increased，and that of the observation group increased more significantly（P<0.01）.TNFα of both groups all significantly decreased，and that of the observation group decreased more significantly than that of the control group（P<0.01）.CD3+ of both groups significantly increased（P<0.05）.CD4+ of both groups were obviously lower than those before the operation，and those at the ninth day after the operation increased more significantly than those at the first day after operation，and the observation increased more significantly（P<0.01）.CD8+ at the first day after operation of both groups increased，but they decreased at the ninth day after operation，and those of the observation group decreased more significantly（P<0.01）.CD4+/CD8+ of the observation group were higher than those of the control group at the ninth day after operation（P<0.01），and at the first day after operation，they were lower than those before operation（P<0.01），but they all increased at the ninth day after operation（P<0.01）.At the ninth day after operation，difference of IgA of both groups was not statistically significant（P>0.05），but at the ninth day after operation，those of the observation group were significantly higher than those of the control group（P<0.01）.Difference of IgG and IgM of both groups was not statistically significant at the first and ninth day after operation（P>0.05）.The incidence of abdominal distension in the observation group was significantly lower than that in the control group（P<0.01），the anal exhaust time at the first time and the recovery time of bowel movement were significantly shorter than those in the control group （P<0.01）.ConclusionGlutamine enteral nutrition can effectively improve the malnutrition and stress status of elderly patients with digestive tract cancer，improve their cellular immune function and humoral immune function，and promote the recovery of gastrointestinal function after operation.endprint

【Key words】glutamine；enteral nutrition；digestive tract tumor；immune index；gastrointestinal function

消化道恶性肿瘤是临床常见的恶性肿瘤之一。该病手术后5～7天内会出现应激反应，可造成患者机体免疫屏障损伤，而肠黏膜屏障功能损伤更为严重，表现为肠道通透性增加，易诱发感染，加重病情，甚至引起多器官功能障碍综合征（MODS），这也是老年患者主要的死因之一[1]。老年消化道肿瘤患者术后往往伴随着不同程度的免疫功能降低和营养不良，术后给予有效的营养支持利于免疫功能和营养状况的改善。目前，国内外许多学者对肠内营养和肠外营养进行研究发现，肠内营养具有明显减低肠道通透性，稳定肠道黏膜的结构，预防细菌移位等作用，故能有效纠正消化道肿瘤患者的营养状况[2]。但提……