The Effects Of Different Nutritional Supports On The Postoperative Clinical Outcomes Of Advanced Gastric Carcinoma Patients

Objectives To compare the effects of different nutritional supports on the postoperative clinical outcomes of advanced gastric carcinoma patients and to find the best nutritional support for them.Methods 54 cases of advanced gastric carcinoma patients were assigned randomly to parenteral nutritional (PN, n= 13), enteral nutritional (EN, n= 13), parenteral and enteral nutritional (PN+EN, n = 16) and fluid therapeutical (control, n=12) group in the 1st day after the operation in General Department of Medical School Hospital of Qingdao University. All patients were given different nutritional supports and fluid replacement more than 7 days. The nutritional and metabolic parameters were evaluated respectively before the procedure and on the first and seventh day after the operation. Parameters investigated in this study included body weight, plasma total protein and albumin and prealbumin concentration, tatal lymphocyte counts, cellular and humoral immunity function, T-cell subgroup ratio and NK cell activity, blood biochemical tests, these were compared with each other in various group. The complications of the operation and nutritional supports, onset of bowel movement, the postoperative length of hospital stay and economic consumption were also observed. The measurement data were analyzed with SPSS 11.0 software, T-test for various data within group, ANOVA for corresponding data among groups; The incidences of complications were statistically analyzed with Chi-squared test. Results(1)Body weight (BW) was decreased significantly after different nutritionalsupports and fluid therapy in all 4 groups that was compared with preoperatively (P<0.05), otherwise, the PN+EN group gently, there were significant differences between PN+EN group and other three groups (F=1.167, PO.05). Comparing PN with EN patients, the BW lose was remarkable in the latter, there were no notable differences between them, but there were predominant differences with the control group (P<0.05 ) .(2)The plasma total protein, albumin and pre-albumin concentration was all elevated after supports in four groups. The differences in the nutritional support groups reached statistical significance, however, the control group did not so. The albumin level in EN and PN+EN was higher than in PN (F = 1.233, P<0.05 ) , but did not return to near the preoperative baseline.(3)Total lymphocyte counts increased after the nutritional supports in these groups and the differences reached statistical significance (P<0.05) , but the control group did not so. Any difference between two groups had no statistical significance (F=3.583, P>0.05) .(4)Cellular immunity function was depressed after the operation; CD3 + lymphocytes