EEN+PN方案对直肠癌根治术围手术期患者营养和免疫指标及康复的影响

赵敏; 桑畅野; 闫长红

doi:10.16766/j.cnki.issn.1674-4152.002655

EEN+PN方案对直肠癌根治术围手术期患者营养和免疫指标及康复的影响

doi: 10.16766/j.cnki.issn.1674-4152.002655

北京大学第三医院延庆医院普外科，北京 102100

基金项目:

北京市优秀人才培养计划资助项目 YQRC2018-0205

详细信息

通讯作者:
赵敏, E-mail: zhaomt1979@163.com

中图分类号: R735.37 R459.3
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出版历程
- 收稿日期: 2021-10-28
- 网络出版日期: 2022-11-29

Effect of EEN and PN scheme on the nutrition indicators, immunological function and rehabilitation in patients undergoing laparoscopic colorectal surgery

Department of General Surgery, Yanqing Hospital of the Third Hospital of Peking University, Beijing 102100, China

摘要

摘要: 目的探讨早期肠内营养(early enteral nutrition，EEN)+胃肠外营养(parenteral nutrition，PN)方案对直肠癌根治术患者营养指标、免疫功能及术后康复的影响。方法选取2019年1月—2020年1月北京大学第三医院延庆医院行直肠癌根治术治疗的90例患者进行回顾性分析。依据营养支持方案不同分为观察组(45例)及对照组(45例)，观察组给予EEN+PN营养支持方案，对照组给予术后全胃肠外营养(total parenteral nutrition，TPN)支持。对比2组患者术后营养指标、免疫功能及术后康复情况。结果观察组术后3 d、术后1周ALB、总蛋白(TP)及前白蛋白(PAB)水平均高于对照组(术后3 d：t=3.640、4.529、3.207，均P＜0.05;术后1周：t=2.047、2.550、4.079，均P＜0.05);观察组术后3 d及术后1周时IgG、IgA及补体C4水平均高于对照组(术后3 d：t=2.058、3.649、10.680，均P＜0.05;术后1周：t=2.897、2.154、6.012，均P＜0.05);观察组术后排气、排便时间及住院时间均短于对照组(t=6.010、5.784、4.851，均P＜0.05);2组患者术后并发症发生率比较差异无统计学意义(22.2% vs. 24.4%，χ²=0.104，P>0.05)。结论直肠癌根治术给予EEN+PN支持方案可有效改善术后患者营养状态，促进术后康复。
- 直肠癌根治术 /
- 早期肠内营养 /
- 胃肠外营养 /
- 全胃肠外营养 /
- 营养指标 /
- 免疫功能
Abstract: Objective To explore the effect of early enteral nutrition (EEN) + parenteral nutrition (PN) schemes on the nutritional indicators, immunological function and postoperative rehabilitation in patients undergoing laparoscopic colorectal surgery. Methods A total of 90 patients who were admitted in our hospital for laparoscopic colorectal surgery were included in the study and divided into the observation group (45 cases) and the control group (45 cases) according to different nutrition support schemes. The patients in the observation group were given EEN + PN scheme, whereas the patients in the control group were given total parenteral nutrition (TPN) support. The nutritional indicators, immunological function and postoperative rehabilitation in the two groups were compared. Results ALB, total protein (TP) and prealbumin (PAB) levels at 3 days and 1 week after operation in the observation group were significantly higher than those in the control group (t value 3 days after operation were 3.640, 4.529 and 3.207, respectively, all P < 0.05; t value 1 week after operation were 2.047, 2.550 and 4.079, respectively, all P < 0.05). IgG, IgA and complement C4 levels at 3 days and 1 week after operation in the observation group were significantly higher than those in the control group (t value 3 days after operation were 2.058, 3.649 and 10.680, respectively, all P < 0.05; t value 1 week after operation were 2.897, 2.154 and 6.012, respectively, all P < 0.05). Exhaustion, defecation and hospitalization time after operation in the observation group were significantly lower than those in the control group (t=6.010, 5.784 and 4.851, respectively, all P < 0.05). The comparison of the occurrence rate of postoperative complications between the two groups was not statistically significant (22.2% vs. 24.4%, χ²=0.104, P>0.05). Conclusion EEN + PN support scheme for patients undergoing laparoscopic colorectal surgery can effectively improve the nutritional status and promote postoperative rehabilitation.
- Laparoscopic surgery for colorectal cancer /
- Early enteral nutrition /
- Parenteral nutrition /
- Total parenteral nutrition /
- Nutritional indicators /
- Immunological function

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表 1 2组直肠癌患者临床资料比较

Table 1. Comparison of clinical data of two groups of rectal cancer patients

组别	例数	性别(男/女, 例)	年龄(x±s, 岁)	NRS 2002评分(x±s, 分)	TNM分期(例)
组别	例数	性别(男/女, 例)	年龄(x±s, 岁)	NRS 2002评分(x±s, 分)	Ⅰ、Ⅱ期	Ⅲ、Ⅳ期
观察组	45	26/19	61.0±7.7	3.4±0.3	24	21
对照组	45	24/21	62.0±6.7	3.3±0.2	25	20
统计量		0.180^a	0.657^b	1.861^b	0.045^a
P值		0.671	0.513	0.067	0.832
注：^a为χ²值，^b为t值。

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表 2 2组直肠癌患者营养指标比较(x±s, g/L)

Table 2. Comparison of nutritional indexes of two groups of rectal cancer patients (x±s, g/L)

组别	例数	ALB
组别	例数	术前	术后3 d	术后1周	F值	P值
观察组	45	39.6±6.5	35.2±5.1^a	36.7±5.1^ab	7.624	0.013
对照组	45	40.2±7.2	31.4±4.8^a	34.6±4.6^ab	7.816	0.012
t值		0.419	3.640	2.047
P值		0.679	< 0.001	0.044

组别	例数	TP
组别	例数	术前	术后3 d	术后1周	F值	P值
观察组	45	66.2±7.3	60.4±7.7^a	64.0±6.1^ab	9.285	0.002
对照组	45	65.6±8.0	53.0±7.8^a	60.8±5.8^ab	9.380	0.008
t值		0.372	4.529	2.550
P值		0.711	< 0.001	0.013

组别	例数	PAB
组别	例数	术前	术后3 d	术后1周	F值	P值
观察组	45	245.6±51.5	190.8±39.2^a	238.0±47.1^ab	25.795	< 0.001
对照组	45	238.0±51.4	164.6±38.3^a	193.6±55.8^ab	23.520	< 0.001
t值		0.701	3.207	4.079
P值		0.485	0.002	< 0.001
注：与术前比较，^aP＜0.05;与术后3 d比较，^bP＜0.05。

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表 3 2组直肠癌患者免疫功能指标比较(x±s，g/L)

Table 3. Comparison of immune function indexes between 2 groups of rectal cancer patients (x±s, g/L)

组别	例数	IgG
组别	例数	术前	术后3 d	术后1周	F值	P值
观察组	45	10.71±1.58	9.55±1.53^a	10.08±1.49^ab	12.492	< 0.001
对照组	45	11.23±1.69	8.83±1.78^a	9.12±1.65^a	11.752	< 0.001
t值		1.537	2.058	2.897
P值		0.128	0.043	0.005

组别	例数	IgA
组别	例数	术前	术后3 d	术后1周	F值	P值
观察组	45	2.30±0.81	2.01±0.69^a	2.16±0.70^a	9.516	0.001
对照组	45	2.46±0.66	1.53±0.55^a	1.88±0.52^ab	8.906	0.006
t值		1.027	3.649	2.154
P值		0.307	< 0.001	0.034

组别	例数	C3
组别	例数	术前	术后3 d	术后1周	F值	P值
观察组	45	1.04±0.33	1.04±0.23	1.01±0.22^ab	7.049	0.024
对照组	45	1.04±0.24	0.80±0.25^a	0.86±0.24^a	8.201	0.001
t值		< 0.001	4.739	3.091
P值		0.999	< 0.001	0.003

组别	例数	C4
组别	例数	术前	术后3 d	术后1周	F值	P值
观察组	45	0.34±0.05	0.18±0.05^a	0.28±0.05^ab	7.103	0.018
对照组	45	0.34±0.05	0.10±0.05^a	0.21±0.06^ab	7.350	0.014
t值		< 0.001	10.680	6.012
P值		0.999	< 0.001	< 0.001
注：与术前比较，^aP＜0.05;与术后3 d比较，^bP＜0.05。

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表 4 2组直肠癌患者术后康复指标比较(x±s)

Table 4. Comparison of postoperative rehabilitation indexes between two groups of rectal cancer patients (x±s)

组别	例数	排气时间(h)	排便时间(h)	住院时间(d)
观察组	45	63.7±12.5	83.6±12.4	8.6±1.8
对照组	45	79.6±12.6	97.5±10.3	10.6±2.1
t值		6.010	5.784	4.851
P值		< 0.001	< 0.001	< 0.001

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