内科Issue(2)：135-140,6.
围术期生长激素和谷氨酰胺强化的肠内营养对原发性肝癌患者术后营养状况和免疫功能影响的初步研究
Evaluation of growth hormone combined with glutamine-enhanced enteral nutritional on status and immune function of postoperative patients with primary liver cancer during perioperative period
摘要
Abstract
Objective To investigate the influence of glutamine-enhanced enteral nutritional(GEEN)combined with growth hormone on postoperative nutritional status and immune function in patients with primary liver cancer during periop-erative period.Methods 48 patients with primary liver cancer were randomly divided into 3 groups:preoperative glutamine-enhanced enteral nutrition group(preoperative GEEN group),postoperative glutamine-enhanced enteral nutrition group (postoperative GEEN group),and parenteral nutrition group.Patients in the postoperative GEEN group were given warm water at 12h after operation and were increased enteral nutrition gradually to the normal level at 24h after operation if no obvious discomfort complained.The patients in postoperative GEEN group were fed enteral nutrition (30mL/kg.d)from d4-7 after operation and the lack of energy supplemented with energy or water,electrolyte within 3 days after operation.The patients in postoperative GEEN group were injected ecombinant human growth hormone(rhGH,4IU/d)from d1-7 days after operation,The common diet was restored gradually after annal exhaust,The patients in the preoperative GEEN group received enteral nutrition before operation for 3 days,30 mL/(kg·d)and had the same nutritional scheme as the patients in postoperative GEEN from d1-4 days after operation,The preoperative GEEN group received rhGH injection for 7 days range from preoperative 3 day to postoperative 4d.Patients in the parenteral nutrition group was supported by parenteral nutrition and taken normal diet when gastrointestinal function recoverying.The clinical recovering and postoperative complication were observed (including wound infections or fat liquefaction,pulmonary infection).Hepatic function,NK cells,CD4+T and CD8+T cells,IgM ,IgA and IgG levels,complement C3 and C5 levels were measured on the 8th day af-ter operation and on the 1 st day before operation.Results Two cases were exited due to complaining to postoperative abdom-inal distension with 1 cases in the preoperative GEEN group and postoperative GEEN group respectively.The patients in 3 groups had no serious complications such as bleeding,operation death.The occurrence of infection was no significant differ-ence(P>0.05)among 3 groups,with fewer rate in preoperative GEEN group.After nutritional support,The level of total protein in both preoperative GEEN group and postoperative GEEN group were higher than that in the parenteral nutrition group(P=0.00),preoperative GEEN group with higher content obviously(P=0.00),No significant changes could be found in albumin levels among the 3 groups(P=0.16),but complement albumin in the GEEN groups was lower than that in the parenteral nutrition group(P=0.02).Before nutritional support,the T cells,immunoglobulin among the 3 groups showed no significant difference(P>0.05),but the percentage of CD3 and the radio of CD3/CD4 were higher than that in the parenteral nutrition group(P<0.05)after nutritional support,less change in the level of NK cell among the 3 groups (P>0.05).In humoral immunity,The levels of IgM,IgA and IgG,C3 and C5 in both preoperative GEEN group and post-operative GEEN group were close to or had been restored to the levels before GEEN support on the eighth days after surger-y (P>0.05),but most indexes of immunity have not yet recovered to the preoperative level in the parenteral nutrition group ,especially the levels of IgM and IgG,were still at the low level(P<0.05).After nutritional support,the levels of preoperative total bilirubin and transaminase were decreased in both preoperative GEEN group and postoperative GEEN group,and were increased in the parenteral nutrition group,but there was no significant difference among the 3 groups. Conclusion Growth hormone combined with glutamine-enhanced enteral nutritional could improve the nutritional status and the immune function ,is safe and feasible for the patients with primary liver cancer during perioperative period.关键词
原发性肝癌/肠内营养/营养状况/免疫功能Key words
Primary liver cancer/Enteral nutrition/Nutritional status/Immune function分类
医药卫生引用本文复制引用
唐双意,钟小斌,尚丽明,黎乐群..围术期生长激素和谷氨酰胺强化的肠内营养对原发性肝癌患者术后营养状况和免疫功能影响的初步研究[J].内科,2014,(2):135-140,6.基金项目
广西壮族自治区卫生厅科研计划项目(合同号:桂卫 Z2005046) （合同号:桂卫 Z2005046）
