| Objective To study the variation of albumin(ALB),prealbumin(PA),retinol binding protein(RBP),transferrin(TRF),IgM and IgG in different nutrition support in patients with gastric cancer surgery,to compare the clinical effect of total parenteral nutrition and enteral and parenteral nutrition for patients.Methods 90 cases of patients with gastric cancer surgery were selected and treated with nutrition support,which stayed in the Gastrointestinal Surgery Department of the Affiliated Hospital of Qingdao University from November,2016 to November,2017.We divided these people into TPN group and EN-PN group,with 45 patients in each group.Patients in two groups were treated with nutritional support for more than five days,starting from the first day after the surgery.Fasting serum samples were collected from the two groups of patients on the day before the surgery,on the first and sixth days after the surgery and then we measured the level of ALB,PA,RBP,TRF,IgM and IgG,then compared the changes of 6 serum indicators in TPN group and EN-PN group.Meanwhile,we compared the duration of mechanical ventilation,length of hospital stay and the incidence of nutrition related complications of patients in both TPN group and EN-PN group.Results(1)There were no statistic difference in serum ALB,PA,RBP,TRF and IgM,IgG levers between TPN group and EN-PN group before the surgery(P>0.05);(2)The serum levels of ALB,PA,RBP,and TRF decreased in the patients in the TPN and EN-PN groups on the first day after surgery compared with before surgery,and the difference was statistically significant(P<0.05).Serum ALB,PA,RBP,and TRF levels increased on the 6th day after surgery compared with the 1st day after surgery and the increase of EN-PN group was significantly higher than that of TPN group,and the difference was statistically significant(P<0.05);(3)In the TPN group,serum PA and RBP levels were lower than those before surgery on the 6th day after surgery,the difference was not statistically significant(P>0.05).Serum ALB and TRF levels were lower than before surgery,the difference was still statistically significant(P<0.05).In the EPN group,serum PA levels were higher on the sixth day after surgery than before surgery,serum RBP levels were lower than before surgery,the difference was not statistically significant(P>0.05).Serum ALB and TRF levels were lower than before surgery,the difference was still statistically significant(P<0.05);(4)In the TPN group and the EN-PN group,the serum IgM and IgG levels decreased on the 1st day after surgery compared with the preoperative level,and the difference was statistically significant(P<0.05).The 6th day after surgery was compared with the first day after surgery,serum IgM and IgG levels were elevated,and EN-PN group was significantly higher than TPN group,the difference was statistically significant(P<0.05);(5)In the TPN group and EN-PN group,the serum IgM and IgG levels were still lower than before surgery on the 6th day after surgery,but the EN-PN group was lower than the TPN group,and the difference was statistically significant(P< 0.05);(6)There was no significant difference in the incidence of nutritional support related complications between TPN and EN-PN groups(P>0.05);(7)The postoperative intestinal ventilation time and hospitalization time of EN-PN group were significantly shorter than that of TPN group,and the difference was statistically significant(P<0.05).Conclusion(1)Serum RBP,TRF and serum ALB and PA have the same trend,and their concentration changes can reflect the nutritional status of gastric cancer patients.Changes in IgM and IgG concentrations can reflect the patient's humoral immune function status.Serum ALB,PA,RBP,TRF,and IgM,IgG concentrations can be evaluated for postoperative nutritional support;(2)The combined application of parenteral and enteral nutrition can better improve patients' status of nutrition and humoral immunologic function than the application of total parenteral nutrition;(3)Compared with the application of total parenteral nutrition,the combined application of parenteral and enteral nutrition can shorten patient's duration of mechanical ventilation and length of hospital stay;(4)Supervise the incidence of nutrition related complication of patients treated with parenteral and enteral nutrition and total parenteral nutrition respectively,to help patients adjust the use of nutrient solution in time and reduce the occurrence of adverse reactions. |
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