Application Of Immunonutrition In Enhanced Recovery After Surgery For Gastric Cancer

Background: In recent years,more and more attention has been paid to the concept of enhanced recovery after surgery(ERAS).Great changes have taken place in perioperative treatment and nursing mode of patients with gastric cancer.Many evidences have also proved that enhanced recovery after surgery program can effectively reduce the occurrence of postoperative complications of patients with gastric cancer and promote the recovery of patients after operation.However,there were also some measures remains much controversial,the application of enteral immunonutrition was one of them.Because of the dysfunction of digestion and absorption of gastrointestinal tract,most patients with gastric cancer were complicated with malnutrition before operation.Malnutrition could lead to immune dysfunction,significantly increase the incidence of postoperative complications and prolong hospitalization time.Therefore,more and more surgeons were aware of the importance of perioperative immunonutrition support for patients with gastric cancer.This study evaluated the effects of postoperative nutritional status,immune function,and inflammatory response on patients with gastric cancer by perioperative immunonutrition support,and further explored the value of enteral immunonutrition support in enhanced recovery after surgery.Methods: There were 64 patients who underwent radical gastrectomy in our hospital from January 2017 to January 2018,were randomly divided into enteral immunonutrition group(EIN group n=32)and standard enteral nutrition group(SEN Group n=32).In the immunonutrition group,oral immunonutrient preparation(Oral IMPACT)was administered from 5 days before surgery to 5 days after surgery,and the standard enteral nutrition group was given normal nutritional preparation.The patient's immune index(ratio of CD4,CD8,CD4/CD8,IgA,IgM and IgG)and the nutritional indicators(serum total protein,serumalbumin,serum prealbumin)in serum were measured.The inflammatory response index,serum C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-?(TNF-?)were measured.Observation of postoperative recovery,including postoperative exhaust time,postoperative short-term complications,postoperative discharge time,body mass index(BMI).All study data were statistically analyzed by SPSS 19.0 software.The difference was statistically significant if P < 0.05.Results: The immune level in EIN group was significantly higher than that in SENgroup on the 1st and 5th day after operation(P < 0.05).The level of inflammation in EIN group was significantly lower than that in SEN group on the1 st and 5th day after operation(P < 0.05).The time of postoperative exhaust and postoperative discharge time in EIN group was shorter than that in SEN group(P < 0.05).There were no significant differences between the two groups in nutritional index,postoperative short-term complications.Conclusion: Perioperative immunonutrition support for patients with gastric cancer can significantly improve postoperative immune level,reduce postoperative inflammatory stress response,and accelerate postoperative recovery time.