Clinical Application of Glutamine Enhanced Hypo-Nitrogen Hypo-Caloric Parenteral Nutrition in Postoperative Stress Period for Gastric Cancer Patients with Nutritional Risk

Objective: This study was to explore the clinical application of hypo-nitrogen hypo-caloric parenteral nutrition(HNHC) for postoperative supplement in gastric cancer patients of nutritional risk in comparison with the classical total parenteral nutrition regimen(TPN).We also studied the clinical significance of glutamine enhanced hypo-nitrogen hypo-caloric parenteral nutrition(GEHN).Methods: The 89 cases gastric cancer patients with NRS-2002 score(3~5) were randomly distributed into 3 groups.The postoperative nutrition support was given by TPN,HNHC and GEHN strategies for 6 days.The blood-glucose,nutritional markers,as well as immunological markers were monitored.Postoperative recovery processes and complications were compared among the three groups.Results:(1).HNHC group gained better blood-glucose control comparing to TPN group.Statistically significant differences were shown on postoperative day 1,2 and 3.(2).All patients from the 3 groups showed negative nitrogen balance after operation.There was no statistically significant difference between TPN and HNHC groups.GEHN group showed a lesser decrease of TRF than in HNHC group from preoperative day 1 to postoperative day 3.The recoveries of the 4 nutritional markers detected were significantly more satisfying in GEHN group than in HNHC group.(3).There was no difference between TPN and HNHC groups by immunological markers examined.Immune function restoration tended to be more rapidly in GEHN group,especially,the recovery of CD3 was significantly faster.(4).The SIRS was more frequent in TPN group.Intestinal peristalsis recovery was significantly faster in GEHN group than HNHC group.Conclusions: Compared with TPN,HNHC was safe and applicable in gastric cancer patients with nutritional risk for short time support after surgery.HNHC support had better blood-glucose control and fewer SIRS.GEHN could effectively improve the postoperative nitrogen balance and immune restoration;shorten the recovery of bowel movement.GEHN is worthy of a parenteral nutrition support regimen in the postoperative stress period.