Different Way Of Nutritional Suppotr For Patients After Total Gastrectomy

Purpose More glutamine enhanced enteral nutrition with conventionalenteral nutrition and parenteral nutrition (stomach) on gastric cancer radicalpatients after impact, explore ways of postoperative reasonable nutritionsupport in patients with gastric cancer.Methods Choose the fellowship at Jilin university hospital in September2012~September2013month implementation (full stomach) in49patientswith gastric cancer radical, were randomly divided into three groups: glutamineenhanced intestinal and fewer ten patients experienced septic complications(Gln group, n=18), conventional enteral and fewer ten patients experiencedseptic complications (EN group, n=16), regular bowel and fewer ten patientsexperienced septic complications (PN group, n=15).Gln group and EN groupafter24h after surgery for isotonic NaCl solution from300to500ml,24h noobvious reaction, such as when a patient is infusion of liquid nitrogen, such asheat of nutritional support10d;Subclavian vein after PN group and24h afternutritional support.Three groups are all in a day, the second day、third day andfifth day after operation and preoperative determination of8am11days afterthe nutrition indicators:1). Physical indicators, including the weight, upper armskinfold, grip strength;2). The nutritional indexes, including total protein,albumin, prealbumin;3.) the humoral immune indexes, includingimmunoglobulin G (IgG), immunoglobulin M (IgM) and immunoglobulin A(IgA);4) cellular immune indexes, including differentiation antigen4(CD4+),8 differentiation antigens (CD8+) and differentiation antigen4/differentiationantigen (CD4+/CD8+)8.Their own groups for results comparison between thegroup and the comparison, and record each anal exhaust time, length of hospitalstay, the incidence of complications and adverse reactions.Results1. The groups of patients in the experimental period, there was no seriouscomplications or death.2. The nutritional indexes of three groups of patients after24h andimmune indexes compared with preoperative declined, but the decline was nostatistical difference between the three groups.3. The3rd d and5th d, three groups of patients with various physicalindexes down, compared with24h postoperatively decline of Gln group wasobviously lower than the other two groups, the decline of EN group wasobviously lower PN group; Postoperative11d, three groups of physical indexesis24h after surgery has improved, but the patient’s weight and grip strengthGln group was obviously higher than that of EN and PN group, and thephysical indexes of EN group was obviously higher than that of PN group.4. Postoperative3rd d and5th d, three groups of patients the nutritionindicators from24h after recovery, recovery Gln group was obviously higherthan that of the other two groups, the recovery speed EN group was obviouslyhigher than that of PN group; Postoperative11d, three groups of nutritionindex is24h after improved, but still lower than the preoperative level; Glngroup and albumin level before EN group was no statistical difference, but thetwo groups were significantly higher than the PN group.5. Postoperative3rd d and5th d, three groups of patients with varioushumoral immune indexes from24h after recovery, the contents of IgM and IgA, the recovery rate of Gln group was obviously higher than that of the othertwo groups, the recovery speed EN group was obviously higher than that of PNgroup; After11d, three groups of humoral immunity indexes down, comparedwith preoperative Gln group and EN IgM elevated levels and PN group hadsignificant difference; Gln group and PN group IgA level higher than in ENgroup; And three groups of IgG levels while the24h after surgery wasincreased, but no statistical difference between the three groups.6. Postoperative3rd d and5th d, three groups of patients the cellularimmune indexes from24h after recovery, including CD4+and CD4+/CD8+the value of the recovery speed of Gln group was obviously higher than that ofthe other two groups, EN group is significantly higher than the PN group, CD8+three groups were decreased, but the decline of Gln group was obviously lowerthan the other two groups, EN and PN group no difference; Postoperative11d,Gln and EN groups of CD4+and CD4+/CD8+levels than24h after surgery hasincreased, the content of CD8+declined obviously, and PN group wasstatistically difference.7. Gln group, the EN group and PN group of postoperative adversereactions, respectively to have1,2and3, the incidence of5.6%,12.5%and26.7%respectively.8. The anus exhaust time and hospital stay, Gln slightly earlier in ENgroup, earlier than the PN group.Conclusion1. The preferred nutrition mode after total gastrectomyis the glutamineenhanced enteral nutrition manner.2.Glutamine enhanced enteral nutrition is better than conventional enteralnutrition and parenteral nutrition improve patients postoperative immunity. 3. Glutamine enhanced enteral nutrition than conventional enteral nutritionand parenteral nutrition is more advantageous to decrease the body’s proteindecomposition rate, promote the synthesis of body protein, is beneficial to therecovery of patients, the body’s repair themselves.4. Glutamine enhanced enteral nutrition can reduce complications, reducethe in-hospital time, is a safer, more effective, more economical way ofnutritional support.