经皮内镜下胃/空肠造口术及瑞能在老年消化道肿瘤患者压力性损伤预防中的作用

Effect of percutaneous endoscopic gastrostomy or jejunostomy and Supportan in prevention of stress injury in elderly patients with digestive tract tumors

  • 摘要:
      目的  探讨经皮内镜下胃/空肠造口术(PEG/J)及瑞能在预防有营养风险老年消化道肿瘤患者压力性损伤中的作用。
      方法  选取年龄≥60岁,禁食及卧床时间≥5 d, 经Waterlow压疮危险评估表和营养风险筛查(NRS2002)评估为压力性损伤且有营养风险的104例老年患者,按回顾性队列研究设计,分为对照组、免疫营养组及普通营养组。比较3组患者压力性损伤发生率、血红蛋白(Hb)、血清白蛋白(ALB)、血清前白蛋白(PA)、体质量指数(BMI)、C反应蛋白(CRP)、白细胞介素-2(IL-2)、总淋巴细胞计数(TLC)、自然杀伤细胞(NK细胞)、CD3+、CD4+、CD8+及CD4+/CD8+
      结果  治疗20 d后,免疫营养组患者的压力性损伤发生率、Hb、ALB、PA、BMI、CRP、IL-2、TLC、NK、CD3+、CD4+及CD4+/CD8+与对照组相比,差异均有统计学意义(P < 0.05或P < 0.01), 普通营养组只有ALB、PA、BMI、CRP、CD4+及CD4+/CD8+与对照组相比有显著差异(P < 0.05或P < 0.01)。
      结论  对于有营养风险的老年压力性损伤高危消化道肿瘤患者,临床采用PEG/J加瑞能进行肠内营养,能有效改善营养状况,减轻炎症反应,提高免疫功能,降低压力性损伤的发生率。

     

    Abstract:
      Objective  To study effect of percutaneous endoscopic gastrostomy or jejunostomy(PEG/J) and Supportan in prevention of stress injury in elderly patients with digestive tract tumors.
      Methods  A total of 104 elderly patients aged 60 years or older, with time of fasting or bedridden ≥5 days, assessed as stress injury risk and malnutriton by Waterlow and Nutritional Risk Screening(NRS2002) were selected. According to a retrospective cohort study, the patients were divided into control group, immune nutrition group and normal nutrition group. The incidences of stress injury, hemoglobin (Hb), serum albumin (ALB), prealbumin (PA), body mass index (BMI), C reactive protein (CRP), interleukin-2 (IL-2), total lymphocyte count (TLC), nature killer (NK) cells, the ratios of CD3+, CD4+, CD8+ and CD4+/CD8+ were compared.
      Results  After 20 d of treatment, there were significnat differences in incidences of stress injury, Hb, ALB, PA, BMI, CRP, IL-2, TLC, NK cells, CD3+, CD4+, and CD4+/CD8+ between the control group and immune nutrition group (P < 0.05 or P < 0.01). However, ALB, PA, BMI, CRP, CD4+ and CD4+/CD8+ were statistically significant in normal nutrition group (P < 0.05 or P < 0.01).
      Conclusion  After being given Supportan through PEG/J to elderly digestive tract tumors patients with risks of stress injury and malnutriton, the nutritional status and immune function will be improved, inflammation reactions and incidences of stress injury will be reduced.

     

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