Clinical Application On Perioperative Immunonutrition Support In Gastric Cancer Patients With Nutritional Risk

Objective:1.To observe the effect of perioperative immunonutrition support on nutritional status and recovery status in gastric cancer patients with nutritional risk.2.To discuss auxiliary role to the idea of ERAS that perioperative immunonutrition support in gastric cancer patients can give play in gastric cancer patients.Methods:Fifty-six gastric cancer patients with nutritional risk were selected by NRS2002,and randomly divided into perioperative immunonutrition support group(IN group,n=28)and generalnutrition support group(GN group,n=28).Patients of IN were given the enteral nutrient(TPF-T,200 m L×2 bottles)on the basis of semi-liquid diet and parenteral nutrition(Kabiven TM PI,1440 m L)for insufficient heat from preoperative 7th day to postoperative 7th day(except the operation day).Patients of GN group were given the enteral nutrient(TP,500 m L)on the basis of semi-liquid diet and parenteral nutrition(Kabiven TM PI,1440 m L)for insufficient heat from preoperative 7th day to postoperative 7th day(except the operation day).The levels of nutrition status(ALB,PA),stress status(TNF-α,IL-6,CRP)and immune function(IgG,IgA,IgM)were detected on postoperative 1th and 8th day.The postoperative anal exhaust time and incidence ratewere observed.Results(1)Nutritional indexes:On postoperative 1th day,the level of PA in IN group were significantly higher than that in GN group(p<0.05),but there were no statistic difference between each group on the serum levels of ALB(p>0.05).On postoperative 8th day,the level of PA and ALB in IN group were significantly higher than those in GN group(p<0.05).(2)inflammatory indexes:On postoperative 1th day,the level of TNF-α,IL-6 and CRP in IN group were significantly lower than that in GN group(p<0.05);On postoperative 8th day,the level of TNF-αand IL-6 in IN group were significantly lower than those in GN group(p<0.05),but there were no statistic difference between each group on the serum levels of CRP(p>0.05).(3)Immunological indexes:On postoperative 1th day,the level of IgG,IgM,IgA were lower than those before operation in both groups,but the decline is more significant in GN group(p<0.05);On postoperative 8th day,there were a recovery of the level of IgG,IgM,IgA recovery in both groups,and the level of Ig M were equal to that of preoperative in contrast with the level of other immunological indexes being still lower than preoperative,but the rise is more significant in IN group(p<0.05).(4)Clinical indexes:3 patients had postoperative complications in IN group,the rate is 10.7%,while as 6patients had postoperative complications in GN group,the rate is21.4%.Anal exhaust time in IN group was(43.17±8.52)h,was significantly shorter than(61±8.54)h in GN group(p<0.05).Conclusion Perioperative immunonutrition support in gastric cancer patients can depress inflammatory indexes,reduce surgical stress,improve the postoperative nutritional status,lower systemic inflammatory reaction,accelerate postoperative recovery,shorterhospital stay,which consistent with the concept of Enhanced Recovery After Surgery.