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研究生:曹雅姿
論文名稱:腸道灌食免疫配方對腹部手術病患免疫反應之影響
論文名稱(外文):Immune Responses in Abdominal Surgery Patients Administrated with Enter Immune Enhancing Formula
指導教授:黃士懿黃士懿引用關係
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:保健營養學系
學門:醫藥衛生學門
學類:營養學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:93
中文關鍵詞:免疫配方腹部手術免疫反應
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本試驗是探討腹部開刀的腸道灌食病患以添加魚油的免疫管灌配方探討其免疫反應之影響。經收案標準評估後將受試者分為兩組,一組給予含有魚油的免疫管灌配方IMPACT-Glutamine® (n=7),另一組給予等熱量(30卡/公斤體重)不含魚油的免疫管灌配方Alitraq® (n=7),病患之疾病嚴重度(APACHE II Score)均小於15,在開始灌食前一天及灌食後第七天各測其免疫反應:CD4、CD8、CD4/CD8、C3、C4、NBT test及其營養狀況albumin、prealbumin並且觀察兩組的消化狀況。研究結果發現兩組之間無論是免疫反應或是營養狀況都無統計差異,但Alitraq®組在灌食前的營養狀況prealbumin比IMPACT-Glutamine®組灌食前好(p = 0.028),不含魚油的Alitraq®組灌食後的營養狀況prealbumin比灌食前明顯增加(p = 0.043),且C3灌食前比灌食後也有明顯的增加(p = 0.018),IMPACT-Glutamine®組灌食前與灌食後營養狀況及免疫反應並無明顯的差異,IMPACT-Glutamine®組七名病患中灌食後有五名病患嚴重腹瀉,不含魚油的Alitraq®組七名病患消化良好無腹瀉的發生。本研究發現含魚油配方IMPACT-Glutamine®無法產生改善病患免疫反應的效果,並產生嚴重的腹瀉現象。
The proposed study was to assess the effectiveness of enhanced fish oil immune enteral feeding formula on the immune responses of patients with abdominal surgery. The patients were divided into two groups, one group was administrated with fish oil enhanced IMPACT-Glutamine® (n=7) formula, another group was given the commercial formula Alitraq® without fish oil (n=7). Two groups were treated with isocalorie (30 kcal/Kg body weight) condition. The APACHE II Score of patients were less than 15. The immune responses (i.e., CD4, CD8, CD4/CD8, C3, C4, and NBT test), the nutrition status (i.e. albumin, prealbumin), and digestion condition (i.e. frequency of diarrhea) of two groups were evaluated before feeding and fed on day 7, respectively. In results, there were no statistical differences before treatment on immune responses and albumin except prealbumin in two groups. The prealbumin level of control group was significant higher than the IMPACT-Glutamine® group (p = 0.028) before treatment. However after administration, the prealbumin (p = 0.043) and C3 (p = 0.018) were significant higher than before treatment in the Alitraq® group. The IMPACT-Glutamine® group was no significant differences between before and after administration in immune response and nutrition status. Five patients fed with enhanced fish oil formula had serious diarrhea. None of the patients presented diarrhea in Alitraq® group. In conclusion, the IMPACT-Glutamine® fish oil enhanced formula did not present the postive immune response of patients with abdominal surgery and resulted in serious diarrhea.
目錄
目錄………………………………………………………………… I
中文摘要…………………………………………………………… IV
英文摘要…………………………………………………………… V
圖目錄……………………………………………………………… VIII
表目錄……………………………………………………………… IX
第一章 腸道灌食配方簡介……………………………………… 1
第一節 腸道灌食的歷史……………………………………… 1
第二節 特殊配方的發展……………………………………… 3
第二章 腹部手術後腸胃道對營養吸收之影響………………… 4
第一節 荷爾蒙的改變………………………………………… 4
第二節 手術併發症的發生…………………………………… 5
第三章 文獻回顧………………………………………………… 6
第一節 n-3不飽和脂肪酸的生理作用……………………… 6
第二節 n-3不飽和脂肪酸在免疫反應機制上的影響……… 7
第三節 n-3不飽和脂肪酸臨床研究………………………… 10
第四節 免疫配方在手術或外傷病患之應用………………… 16
第五節 魚油介入之安全性研究……………………………… 18
第四章 研究動機與目的………………………………………… 19
第五章 實驗設計與方法………………………………………… 20第一節 受試者的篩選與分組………………………………… 20
第二節 實驗流程……………………………………………… 20
第三節 檢驗項目……………………………………………… 21
一、 基本資料……………………………………………… 21
二、 血液生化檢查………………………………………… 21
三、 APACH II score疾病嚴重度指標評估……………… 28
第四節 IMPACT-Glutamine®與Alitraq®配方之比較………… 29
第五節 資料處理及分析……………………………………… 30
第六章 結果……………………………………………………… 31
第一節 IMPACT-Glutamine®組與Alitraq®組之各項比較…… 31
第二節 IMPACT-Glutamine®組與Alitraq®控制組介入前之營養
狀況比較結果………………………………………… 49
第三節 IMPACT-Glutamine®組介入前後之各項比較結果… 52
第四節 Alitraq®組介入前後之各項比較結果………………… 64
第七章 討論……………………………………………………… 76
第一節 營養支持給予時機之探討…………………………… 76
第二節 營養支持成份之探討………………………………… 78
第三節 營養支持途徑之探討………………………………… 80
第四節 營養狀況與免疫反應之探討………………………… 82
第五節 腸胃道灌食腹瀉之探討……………………………… 84
第八章 結論……………………………………………………… 88
第九章 參考文獻………………………………………………… 89
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