摘要
目的:探讨实现最佳危重症能量供给的联合营养策略。方法:选取2017年1月—2019年1月期间新疆生产建设兵团第四师医院重症医学科患者84例,根据营养支持方案不同分为对照组和观察组,两组各42例。对照组给予单纯肠内营养(EN),观察组给予EN联合补充性肠外营养(SPN)。比较两组入组第1天、第4天及终点事件时营养指标[前白蛋白(PA)、血红蛋白(Hb)、白蛋白(Alb)、上臂围]、免疫功能指标[总淋巴细胞计数(TLC)、人类白细胞抗原(HLA-DR)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)]、肠黏膜屏障功能[D-乳酸、肠型脂肪酸结合蛋白(IFABP)]、血清炎症因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、IL-1β]水平及临床结局指标。结果:终点事件时两组PA、Hb、Alb高于入组第1天、入组第4天,且观察组高于对照组,差异有统计学意义(P<0.05);终点事件时两组TLC、HLA-DR、IgM、IgG高于入组第1天、入组第4天,且观察组高于对照组,差异有统计学意义(P<0.05);终点事件时两组血清D-乳酸、IFABP水平低于入组第1天、入组第4天,且观察组低于对照组,差异有统计学意义(P<0.05);终点事件时两组血清TNF-α、IL-6、IL-1β水平低于入组第1天、入组第4天,且观察组低于对照组,差异有统计学意义(P<0.05);观察组感染性休克、全身多器官功能衰竭发生率、SOFA、APACHEⅡ评分低于对照组,两组比较差异有统计学意义(P<0.05)。结论:联合营养(EN+SPN)应用于危重症患者,可更好地提高机体营养状态,增强机体免疫力,改善肠黏膜屏障功能,抑制炎症反应激活,改善临床结局。
Objective:Explore the strategy of combined nutrition to achieve the best critically ill energy supply.Methods:A total of 84 adult comprehensive ICU patients in our hospital from January 2017 to January 2019 were selected and divided into different groups according to the nutritional support plan,with 42 cases in each group.The control group was given simple enteral nutrition(EN),and the observation group was given EN combined with supplementary parenteral nutrition(SPN).The nutritional indicators[prealbumin(PA),hemoglobin(Hb),albumin(Alb),upper arm circumference],immune function indicators[total lymphocyte count(TLC),human leukocyte antigen(HLA-DR),immunoglobulin M(IgM),immunoglobulin G(IgG) ],intestinal mucosal barrier function[D-lactic acid,intestinal fatty acid binding protein(IFABP) ],serum inflammation Factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-1β]levels and clinical outcome indicators.Results:The PA,Hb,and Alb of the two groups were higher than those on the 1 st day and 4 th day after the entry,and the observation group was higher than the control group,the difference was statistically significant(P<0.05);the two groups of TLC,HLA-DR,IgM,HLA-DR,IgM,IgG was higher than on the 1 st day and 4 th day of enrollment,and the observation group was higher than that of the control group,the difference was statistically significant(P<0.05);the serum D-lactic acid and IFABP levels of the two groups were lower than those on the 1 st day,enrollment On the 4 th day,the observation group was lower than the control group,the difference was statistically significant(P<0.05);the serum TNF-α,IL-6,and IL-1β levels of the two groups were lower than those on the 1 st and 4 th day of enrollment at the end of the event,and The observation group was lower than the control group,the difference was statistically significant(P<0.05);the incidence of septic shock,systemic multiple organ failure,SOFA and APACHE Ⅱ score in the observation group were lower than those in the control group,the difference was statistically significant(P<0.05).Conclusion:EN+SPN applied to critically ill patients can better improve the body’s nutritional status,enhance the body’s immunity,improve the intestinal mucosal barrier function,inhibit the activation of inflammatory response,and improve the clinical outcome.
作者
潘金萍
刘菁
都军
程琳
宋辉
PAN Jinping;LIU Jing;DU Jun;CHENG Lin;SONG Hui(Nutrition Room,Fourth Division Hospital of Xinjiang Production and Construction Corps,Xinjiang,835000,China;Institute of Nutrition, Xinjiang Uygur Autonomous Region People’s Hospital;Department of Critical Care Medicine, Fourth Division Hospital of Xinjiang Production and Construction Corps;Department of Pharmacy, Fourth Division Hospital of Xinjiang Production and Construction Corps)
出处
《临床急诊杂志》
CAS
2022年第4期231-236,共6页
Journal of Clinical Emergency
基金
2017年度四师可克达拉市科技计划(No:2107YL002)。
关键词
肠内营养
补充性肠外营养
危重症
能量供给
免疫功能
肠黏膜屏障功能
enteral nutrition
supplementary parenteral nutrition
critically ill
energy supply
immune function
intestinal mucosal barrier function
