Abstract: Objective:To explore the clinical effects of argininerich enteral nutritional support therapy in patients undergoing gastrectomy.
Methods:The clinical data of 84 patients with gastric carcinoma who were admitted to the Wuhan Central Hospital from January 2013 to December 2014 were retrospectively analyzed. After gastrectomy, 42 patients undergoing argininerich enteral nutritional support therapy were allocated to the argininerich enteral nutrition (AEN) group and 42 patients undergoing standardized enteral nutritional support therapy were allocated to the enteral nutrition (EN)  group. The indexes of nutrition ［BMI of patients were calculated 〖HJ0〗and serum total protein (TP), albumin (Alb) and prealbumin (PAB) were detected］ and immunology ［Tlymphocyte subsets, total number of lymphocyte, white blood cell (WBC) and CD4+/CD8+ were detected by flow cytometry］, postoperative complications and indexes of prognosis were analyzed. The measurment data with normal distribution were presented as ±s. The comparision between groups were evaluated with the t test and repeated measures ANOVA. The count data were analyzed using the chisquare test.
Results:The value of TP from preoperation to postoperative day 7 was from (64±16)g/L to (55±13)g/L in the AEN group and from (65±21)g/L to (52±11)g/L in the EN group, with no significant difference between the 2 groups (F=29.653, P>0.05). The values of Alb and PAB from preoperation to postoperative day 7 were from (33±17)g/L to (32±3)g/L and from(0.20±0.01)g/L to (0.26±0.06)g/L in the AEN group and from (32±19)g/L to (27±5) g/L and from (0.20±0.03)g/L to (0.22±0.03)g/L in the EN group, respectively, with significant differences in the Alb and PAB between the 2 groups (F=21.784, 10.653, P<0.05). The number of WBC, number of lymphocyte and percentage of CD8+Tcell in the AEN group were (5.3±0.7)×109/L, (1.39±0.06)×109/L and 17.3%±3.5% before operation and (5.9±0.7)×109/L, (1.33±0.03)×109/L and 18.4%±3.8% after operation. The number of WBC, number of lymphocyte and percentage of CD8+Tcell in the EN group (5.1±0.5)×109/L, (1.40±0.04)×109/L and 16.4%±2.8% before operation and (5.4±0.5)×109/L, (1.23±0.04)×109/L and 17.3%±3.1% after operation. There was no significant difference in the above indexes between the 2 groups (F=17.429, 20.461, 38.820, P>0.05). The percentages of CD4+Tcell and CD4+/CD8+ before operation and at postoperative day 10 were 34.7%±5.4%, 39.5%±3.9% and 1.80±0.29, 2.23±0.32 in the AEN group, and 33.2%±4.6%, 34.6%±2.4% and 1.73±0.26, 1.82±0.42 in the EN group，respectively, with no significant difference in the above indexes between the 2 groups  (F=14.398, 7.473, P<0.05). The incidences of postoperative complication in the AEN group and in the EN group were 9.5%(4/42) and 31.0%(13/42), showing a significant difference between the 2 groups (χ²=4.459, P<0.05). The duration of postoperative systemic inflammatory response syndrome (SIRS) were (1.3±0.6)days in the AEN group and (2.4±1.0)days in the EN group，with a significant difference between the 2 groups (t=6.360, P<0.05). The time to anal exsufflation and time of bowel movements were (2.6±0.3)days and (3.6±0.5)days in the AEN group and (2.5±0.3)days and (3.5±0.5)days in the EN group, respectively, with no significant difference between the 2 groups (t=1.570, 0.897, P>0.05)。There was no perioperative death. The hospital expenses were (17 000±4 000)yuan in the AEN group and (22 000±5 000)yuan in the EN group, with a significant difference between the 2 groups(t=3.860, P<0.05).
Conclusion:Argininerich enteral nutritional support therapy is superior to standardized enteral nutrition in effectively improving postoperative nutrition status, immune function and prognosis of patients undergoing gastrectomy.