【目的】 探讨黄芪建中汤联合肠内营养支持对胃癌术后营养不良患者的临床疗效。【方法】 回顾性选取 2022 年 1 月至 2024年12月于苏州市中西医结合医院就诊的120例脾胃虚寒型胃癌术后营养不良患者，根据治疗方案不同将患者分为观察 组和对照组，每组各60例。对照组仅术后常规肠内营养支持，观察组在对照组的基础上联合黄芪建中汤治疗，2组疗程均为 12周。观察2组患者治疗前后血虚量化指标、免疫功能指标（ T淋巴细胞亚群）、欧洲癌症研究与治疗组织患者生活质量测定 量表（EORTC QLQ - C30）评分及中医证候积分的变化情况，并评估2组患者的临床疗效和治疗方案的安全性。【结果】（1）疗效 方面，治疗 12周后，观察组的总有效率为 90.00%（54/60），对照组为 75.00%（45/60），组间比较（χ2 检验），观察组的疗效明 显优于对照组，差异有统计学意义（P＜0.05）。（2）血虚量化指标方面，治疗后，2 组患者的血红蛋白再合成率（Hb-RS）、 舌下微循环血流速度（LBFV）、组织氧合指数（StO2 ）及甲襞毛细血管密度（NFD）均较治疗前升高（P＜0.05），且观察组对 Hb-RS、LBFV、StO2及 NFD的升高幅度均明显优于对照组（P＜0.01）。（3）免疫功能方面，治疗后，2组患者的 T淋巴细胞亚 群CD3+ 、CD4+ 和CD4+ /CD8+ 水平均较治疗前升高（P＜0.05），CD8+ 水平均较治疗前降低（P＜0.05），且观察组对CD3+ 、CD4+ 和 CD4+ /CD8+ 水平的升高幅度及对CD8+ 水平的降低幅度均明显优于对照组（P＜0.01）。（4）生活质量方面，治疗后，2组患者EORTC QLQ-C30的躯体功能、整体健康状况评分均较治疗前升高（P＜0.05），疲劳、食欲减退评分均较治疗前降低（P＜0.05），且观 察组对躯体功能、整体健康状况评分的升高幅度及对疲劳、食欲减退评分的降低幅度均明显优于对照组（P＜0.01）。（5）中医 证候积分方面，治疗后，2 组患者的中医证候积分均较治疗前明显降低（P＜0.01），且观察组的降低幅度明显优于对照组（P＜0.01）。（6）安全性方面，治疗过程中，观察组的不良反应发生率为8.33%（5/60），明显低于对照组的23.33%（14/60），差 异有统计学意义（P＜0.05）。【结论】 黄芪建中汤联合肠内营养支持可显著改善脾胃虚寒型胃癌术后营养不良患者营养状态和 免疫功能，加速疾病康复进程，提高患者生活质量。

Objective To investigate the clinical efficacy of Huangqi Jianzhong Decoction combined with enteral nutrition support in patients with postoperative malnutrition after gastric cancer surgery. Methods A retrospective analysis was conducted on 120 patients with postoperative malnutrition after gastric cancer surgery，characterized by spleen-stomach deficiency-cold syndrome， who were treated at Suzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2022 to December 2024. Based on the treatment regimens，patients were divided into an observation group and a control group，with 60 patients in each group. The control group received only conventional postoperative enteral nutrition support，while the observation group received Huangqi Jianzhong Decoction in addition to the enteral nutrition support. The treatment course for both groups was 12 weeks. Changes in quantitative blood deficiency indicators， immune function indicators （T lymphocyte subsets）， European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30（EORTC QLQ-C30） scores，and traditional Chinese medicine （TCM） syndrome scores were observed before and after treatment. The clinical efficacy and safety of the two treatment regimens were evaluated. Results （1） Regarding efficacy，after 12 weeks of treatment，the total effective rate was 90.00% （54/60） in the observation group，significantly higher than 75.00% （45/60） in the control group. Intergroup comparison （by chi-square test） showed that the efficacy of the observation group was significantly superior to that of the control group， with a statistically significant difference （P＜0.05）.（2） Regarding quantitative indicators of blood deficiency， after treatment， hemoglobin resynthesis rate （Hb-RS），lingual blood flow velocity （LBFV），tissue oxygen saturation （StO2 ），and nailfold capillary density （NFD） were increased in both groups compared to those before treatment （P＜0.05），and the increases were significantly greater in the observation group than in the control group （P＜0.01）.（3） Regarding immune function，after treatment，the levels of T lymphocyte subsets CD3+，CD4+，and the CD4+ /CD8+ ratio were increased in both groups compared to those before treatment （P＜0.05），while CD8+ levels were decreased （P＜0.05）. The increases in CD3+，CD4+，and the CD4+ /CD8+ ratio，as well as the decrease in CD8+，were significantly greater in the observation group than in the control group （P＜0.01）.（4） Regarding quality of life， after treatment，the scores of items of physical functioning and global health status of the EORTC QLQ-C30 were increased in both groups compared to those before treatment （P＜0.05），while fatigue and loss of appetite scores were decreased （P＜0.05）. The improvements in physical functioning and global health status scores， and the reductions in fatigue and loss of appetite scores，were significantly greater in the observation group than in the control group （P＜0.01）.（5） Regarding TCM syndrome scores， after treatment， TCM syndrome scores were significantly decreased in both groups compared to those before treatment （P＜0.01）， and the reduction was significantly greater in the observation group than in the control group （P＜0.01）.（6） Regarding safety， the incidence of adverse reactions during treatment was 8.33% （5/60） in the observation group，significantly lower than 23.33% （14/60） in the control group， with a statistically significant difference （P＜0.05）. Conclusion Huangqi Jianzhong Decoction combined with enteral nutrition support can significantly improve nutritional status and immune function， accelerate the recovery process， and enhance the quality of life in patients with postoperative malnutrition after gastric cancer surgery presenting with spleen-stomach deficiency-cold syndrome.

R273.352

江苏省卫生健康委科研项目（编号：Z2022064）；江苏省中医药学会科研项目（编号：ZXFZ2024068）