免疫营养在胃肠道恶性肿瘤围手术期中的应用

Application of immunonutrition in the perioperative period of gastrointestinal malignancies

  • 摘要: 胃肠道恶性肿瘤发病率较高,且有40%~80%的胃肠道肿瘤患者存在营养不良,肿瘤疾病本身的代谢机制及以手术为主的治疗方式导致围手术期应激反应可进一步加重营养不良。因此,对有营养风险或营养不良的围手术期肿瘤患者应常规进行营养支持。长期以来,以谷氨酰胺、ω‑3脂肪酸、精氨酸及核苷酸等为主的免疫营养素在围手术期肿瘤患者中的治疗备受关注。围手术期免疫营养治疗不仅可以改善营养缺乏,纠正营养不良;还能维持机体免疫功能和减轻炎症反应;以及维护肠屏障完整性,减少术后并发症发生率和缩短术后住院时间等。然而,近年来随着免疫营养在临床上的广泛应用与深入研究,其在胃肠道恶性肿瘤围手术期的应用仍存在争议。笔者就胃肠道恶性肿瘤患者围手术期免疫营养素的药理机制与临床应用、免疫营养素围手术期联合应用、免疫营养应用时机等方面进行综述,为其临床应用提供依据。

     

    Abstract: The incidence of gastrointestinal malignancies is high in the population, and 40%‒80% of gastrointestinal tumor patients suffer from malnutrition. The metabolic mechanism of tumor disease itself, and the perioperative stress reaction caused by surgical treatment can further aggravate malnutrition. Therefore, nutritional support should be routinely provided during the perioperative period in tumor patients with nutritional risk or malnutrition. For a long time, immunonutrients such as glutamine, ω‑3 fatty acids, arginine and nucleotides have attracted much attention in the treatment of perioperative tumor patients. Most studies have shown that perioperative immunonutrition therapy not only improve nutritional deficiency and correct malnutrition, but also maintain immune function, reduce inflammation and maintain intestinal barrier integrity, to reduce postopera-tive complications and short postoperative duration of hospital stay. However, with the extensive clinical application and in‑depth study of immunonutrition in recent years, there are still many doubts and controversies about its application in the perioperative gastrointestinal malignancies. The authors review the pharmacological mechanism and clinical application of perioperative immunonutrients, perioperative combined application of immunonutrients, and application timing and approach of immunonutrition in patients with gastrointestinal malignancies, so as to provide some clues for its subsequent clinical application.

     

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