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目的探讨早期肠内营养(EN)对老年食管贲门癌患者术后营养状况、肠黏膜通透性及免疫功能的影响。方法行食管贲门癌手术患者96例分为两组,术后分别采用肠内营养(EN组,50例)和肠外营养(PN组,46例)。比较两组患者术后恢复情况,监测肝功能,检测外周血二胺氧化酶(DAO)活性、D-乳酸水平、血浆内毒素含量以及血液炎性细胞因子和免疫球蛋白含量等。结果与PN组比较,EN组患者术后排气排便时间早、并发症少、住院时间短、白蛋白水平高(P<0.05)。术后第7天,EN组DAO活性、D-乳酸水平和内毒素含量均低于PN组(P<0.05),而血浆IgA、IgG、IgM、CD4的水平均高于PN组(P<0.05),IL-2、IL-6和TNF-α均低于PN组(P<0.05)。结论早期EN可有效改善老年食管贲门癌患者术后营养状况,保护肠黏膜屏障,并能有效提高患者术后的免疫功能。
Objective To investigate the effect of early enteral nutrition (EN) on nutritional status, intestinal mucosal permeability and immune function in elderly patients with esophageal and cardiac cancer. Methods Ninety-six patients with esophageal and cardiac cancer were divided into two groups. Enteral nutrition (EN group, n = 50) and parenteral nutrition group (n = 46) were used after operation. The postoperative recovery of the two groups was compared, the liver function was monitored, the activities of DAO, D-lactate, endotoxin, blood inflammatory cytokines and immunoglobulin in peripheral blood were detected. Results Compared with PN group, patients in EN group had earlier postoperative effusion and defecation, less complications, shorter hospital stay and higher albumin level (P <0.05). DAO activity, D-lactate level and endotoxin level in EN group were lower than those in PN group on the 7th day (P <0.05), while plasma levels of IgA, IgG, IgM and CD4 were higher than those in PN group ), IL-2, IL-6 and TNF-α were lower than those in PN group (P <0.05). Conclusion Early EN can effectively improve the nutritional status of elderly patients with esophageal and cardiac cancer, protect the intestinal mucosal barrier, and can effectively improve postoperative immune function.