Effect Of Postoperative Early Enteral Immunonutrition On Nutrition, Immune, Stress Status And Clinical Outcome In Gastrointestinal Cancer Patients

Purpose To investigate the clinical effect of postoperative early enteral immunonutrition on nutritional status, immune function, stress status and clinical outcome of the gastrointestinal cancer patients ,through the compare with postoperative early standard enteral nutrition and postoperative early parenteral nutrition, evaluate the applied potence of the enteral immunonutrition.Methods Seventy-two patients with gastrointestinal cancer were randomly, equally divided into 3 groups: immune-enhancing enteral nutrition group(IEN group,n=24), standard enteral nutrition group (SEN group,n=24),parenteral nutrition group(PN group,n=24), The other 24 cases of benign diseases, which dated for selective operation were fetched as compare controll group (n=24).In the IEN group ,immune-enhancing nutrition fibre was infused on the first morning after operation untill eight days late. In the SEN group , standard enteral nutrition fibre was infused on the first morning after operation,which would be last eight days as the same way.In the PN group , PN support was commenced on the first morning after operation and ran continuously for 8 consecutive days. The levels of albumin(ALB), pre-albumin(PAB), transferrin(TF),CD3, CD4, CD8 , the ratio of CD4/CD8, IgA, IgM, IgG, C3, C4 and C reacting protein(CRP)were detected before operation and on postoprative day 1,4,9. And the length of restoration of bowel function and hospital stay were determinged, the postoperative infections were observed, the nutrition support cost and the total cost were reckoned.Results On preoperation, the concentration of ALB, PAB, TF, CD3, CD4,IgA, IgM, IgG and the ratio of CD4/CD8 of 72 patients with gastrintestinal cancer were less than blank group(P<0.05), while the concentrations of CD8 and CRP, C3, C4 were higher than those in blank group (P<0.05). On the 9th day after operation, there were no statistic meaning on nutrition index in each group(P>0.05).The levels of CD3, CD4 and the ratio of CD4/CD8 were higher in IEN group than in SEN group(P<0.05) ,and significantly higher than in PN group(P<0.01), while the concentrations of CD8 were obviously lower than in PN group(P<0.01),The levels of IgA, IgM, IgG were higher in IEN group than in SEN group(P<0.05),and significantly higher than in PN group(P<0.01) .The levels of CRP were significantly lower in IEN group than both in SEN and PN group(P<0.01), There were no diffience in the levels of C3,C4 in each group(P>0.05). The length of restoration of bowel function was significantly shorter in IEN group than in PN group(P<0.01), The length of hospital stay was shorter in IEN group than in PN group(P<0.01),The cost was lower in IEN group than in PN group(P<0.01). The cases of postoperative infectious complications were smaller in IEN group than in PN group, but there was no statistic meaning in each group.Conclusions Postoperative early enteral nutrition was safe and effective in the gastrointestinal cancer patients. IEN and SEN do better in retrieving the function of immune, lowing systemic inflammatory reaction , quicking bowel function recovery, shorting the length of hospital stay, reducing the rate of postoperative complications and saving cost than PN in the gastrointestinal patients,meanwhile,IEN outweights SEN totally.