中文摘要：

目的：本研究旨在探讨存在营养风险的胃癌患者根治术后应激期采用低氮低热量（HNHC）及谷氨酰胺强化的低氮低热量（GEHN）营养支持方案的临床应用价值。方法：NRS评分（3～5分）的胃癌患者89例,随机分为3组。术后分别给予传统热氮量支持方案（TPN）、HNHC及GEHN 6天。监测血糖水平,营养指标,免疫指标,及术后恢复情况。结果：（1）.术后血糖水平HNHC组的明显优于TPN组,在术后第1、2、3天组间差异有统计学显著性意义。（2）.术后短期三组均存在负氮平衡,HNHC与TPN组比较各营养指标变化情况无统计学差异。HNHC与GEHN组比较：术前1天至术后第3天,转铁蛋白的下降幅度GEHN组明显低于于HNHC组;术后第3天至第6天、术前1天至术后第6天,GEHN中四种蛋白回升幅度明显大于HNHC,差异均存在统计学意义。（3）.术后三组免疫指标,TPN组与HNHC组无统计学显著性差异,GEHN组有优于前两组的倾向,其中CD3变化存在统计学差异。（4）.SIRS的发生数HNHC组少于TPN组,GEHN组术后排气时间明显较HNHC组快。结论：与传统TPN相比,HNHC在存在术前营养风险的胃癌患者术后应激期短期应用安全可行。HNHC方案术后应激期血糖水平稳定,全身炎症反应综合症低。GEHN方案能有效改善术后氮平衡、提高免疫水平、缩短肠蠕动恢复时间。GEHN是值得临床推广的术后应激期肠外营养支持方案。

英文摘要：

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