Department of Cardiothoracic Surgery, The Affiliated Jiangyin Hospital, Southeast University Medical College, Jiangyin 214400, China;
Chin J Cancer Res. 2013 Jun;25(3):299-305. doi: 10.3978/j.issn.1000-9604.2013.06.01.
To explore the effect of early enteral nutrition (EN) on postoperative nutritional status, intestinal permeability, and immune function in elderly patients with esophageal cancer or cardiac cancer.
A total of 96 patients with esophageal cancer or cardiac cancer who underwent surgical treatment in our hospital from June 2007 to December 2010 were enrolled in this study. They were divided into EN group (n=50) and parenteral nutrition (PN) group (n=46) based on the nutrition support modes. The body weight, time to first flatus/defecation, average hospital stay, complications and mortality after the surgery as well as the liver function indicators were recorded and analyzed. Peripheral blood samples were collected on the days 1, 4 and 7 after surgery. The plasma diamine oxidase (DAO) activity and D-lactate level were determined to assess the intestinal permeability. The plasma endotoxin levels were determined using dynamic turbidimetric assay to assess the protective effect of EN on intestinal mucosal barrier. The postoperative blood levels of inflammatory cytokines and immunoglobulins were determined using enzyme-linked immunosorbent assay (ELISA).
After the surgery, the time to first flatus/defecation, average hospital stay, and complications were significantly less in the EN group than those in the PN group (P<0.05), whereas the EN group had significantly higher albumin levels than the PN group (P<0.05). On the 7th postoperative day, the DAO activity, D-lactate level and endotoxin contents were significantly lower in the EN group than those in the PN group (all P<0.05). In addition, the EN group had significantly higher IgA, IgG, IgM, and CD4 levels than the PN group (P<0.05) but significantly lower IL-2, IL-6, and TNF-α levels (P<0.05).
In elderly patients with esophageal cancer or cardiac cancer, early EN after surgery can effectively improve the nutritional status, protect intestinal mucosal barrier (by reducing plasma endoxins), and enhance the immune function.
探讨早期肠内营养（EN）对老年食管癌或贲门癌患者术后营养状态、肠通透性和免疫功能的影响。
选择我院 2007 年 6 月至 2010 年 12 月行手术治疗的 96 例食管癌或贲门癌患者，按营养支持方式分为肠内营养（EN）组（n=50）和肠外营养（PN）组（n=46）。记录并分析两组患者术后体质量、首次排气/排便时间、平均住院时间、并发症及病死率，检测并比较两组患者术后肝功能指标。分别于术后第 1、4、7 天采集外周静脉血，检测血浆二胺氧化酶（DAO）活性和 D-乳酸水平，评估肠通透性；动态比浊法检测血浆内毒素含量，评估 EN 对肠黏膜屏障的保护作用；酶联免疫吸附试验（ELISA）检测术后血炎症细胞因子和免疫球蛋白水平。
术后，EN 组首次排气/排便时间、平均住院时间及并发症发生率均显著低于 PN 组（P<0.05），而白蛋白水平显著高于 PN 组（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显著低于 PN 组（均 P<0.05）。此外，EN 组 IgA、IgG、IgM 和 CD4 水平显著高于 PN 组（均 P<0.05），而 IL-2、IL-6 和 TNF-α水平显著低于 PN 组（均 P<0.05）。
老年食管癌或贲门癌患者术后早期给予 EN 支持治疗可有效改善营养状态，保护肠黏膜屏障（降低血浆内毒素水平），增强免疫功能。
