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目的探讨老年胃癌行全胃或次全胃切除术后早期肠内营养的可行性及护理,并比较早期肠内营养和肠外营养对胃癌根治术患者术后机体恢复情况及免疫功能的影响。方法对2009年12月至2011年12月因胃癌行胃癌根治术的患者术中经鼻置空肠营养管术后早期予以肠内营养治疗与护理,并与肠外营养患者的治疗护理进行比较分析,记录两组患者术后通气时间及住院时间,并于术前1d和术后第1、7天采用流式细胞仪检测胃癌患者外周血CD3+、CD4+、CD8+及NK细胞活性。结果术后早期肠内营养组患术后通气时间及住院天数均少于肠外营养组(P<0.05);术后第1天,两组患者外周血CD3+、CD4+、CD4+/CD8+及NK细胞活性较术前均显著降低(P<0.05),但两组之间比较无显著性差异(P>0.05)。早期肠内营养组患者术后7d上述指标迅速恢复至接近术前水平,而肠外营养组术后7d内持续处于低水平,并显著低于早期肠内营养组(P<0.05)。结论胃癌根治术后患者早期肠内营养使患者机体恢复快,对机体免疫功能影响小。
Objective To investigate the feasibility and nursing of early enteral nutrition after total or subtotal gastrectomy in elderly patients with gastric cancer and to compare the effects of early enteral nutrition and parenteral nutrition on postoperative recovery and immune function. Methods From December 2009 to December 2011, patients undergoing radical gastrectomy for gastric cancer underwent nasogastric jejunal nutrition management during the early postoperative period. The patients were treated with enteral nutrition and compared with those of parenteral nutrition treatment . The postoperative ventilatory time and hospital stay of both groups were recorded. The activities of CD3 +, CD4 +, CD8 + and NK cells in peripheral blood of gastric cancer patients were detected by flow cytometry at 1 day before operation and 1,7 days after operation. Results The postoperative early enteral nutrition group had less postoperative ventilatory time and days of hospitalization than those of parenteral nutrition group (P <0.05). On the first postoperative day, the levels of CD3 +, CD4 +, CD4 + / CD8 + and NK cells The activity was significantly lower than that before operation (P <0.05), but there was no significant difference between the two groups (P> 0.05). In the early enteral nutrition group, the above indexes rapidly recovered to the preoperative level on the 7th day after operation, while the parenteral nutrition group remained at a low level within 7 days after operation and was significantly lower than that of the early enteral nutrition group (P <0.05). Conclusion Early enteral nutrition in patients with radical resection of gastric cancer makes patients recover quickly and has little effect on immune function.