含ω-3多不饱和脂肪酸肠内免疫营养支持对重型颅脑损伤机械通气患者呼吸机相关性肺炎的影响  

Effects of enteral immunonutrition supplemented with omega-3 polyunsaturated fatty acid on the incidences of ventilator associated pneumonia complications in patients with severe traumatic brain injury undergoing ventilator therapy

作　　者：刘金霞[1] 陈祥荣[1] 黄天造[1] 董碧丽 蔡玉新 胡伟鹏[1] Liu Jinxia;Chen Xiangrong;Huang Tianzao;Dong Bili;Cai Yuxin;Hu Weipeng

机构地区：[1]福建医科大学附属第二医院神经外科,福建泉州362000

出　　处：《中华临床营养杂志》2018年第5期267-271,共5页Chinese Journal of Clinical Nutrition

基　　金：福建省自然科学基金(2015J01443);福建省科技创新联合资金(2017Y9201).

摘　　要：目的探讨含ω-3多不饱和脂肪酸(PUFA)肠内免疫营养支持对重型颅脑损伤机械通气患者呼吸机相关性肺炎发生、危重程度、炎症反应及预后的影响。方法选择2015年1月至2017年6月收治的重型颅脑损伤患者64例,按照随机数字表法分为对照组(未添加ω-3PUFA肠内营养组,32例)和研究组(添加ω-3PUFA肠内营养组,32例)。利用血细胞分析仪检测血白细胞(WBC)和中性粒细胞比例(N%),酶联免疫吸附试剂盒检测C反应蛋白(CRP)和前降钙素原(PCT)血清浓度。比较两组患者格拉斯哥昏迷量表(GCS)评分、急性生理与慢性健康评分(APACHE)Ⅱ、临床肺部感染评分(CPIS)、肺功能和预后。结果肠内营养实施14d,与对照组比较,研究组患者呼吸机相关性肺炎发生率(66%比56%,P=0.048)、感染危重程度、CPIS评分(8.25±0.60比7.47±0.53,P=0.036)降低,肺功能指标[用力肺活量:(2.89±0.19)比(3.46±0.22)L,P=0.010;一秒用力呼气容积:(2.35±0.16)L比(2.84±0.24)L,P=0.040;一秒用力呼气容积/用力肺活量%:(49.11±3.34)%vs.(56.00±2.64)%,P=0.038]均呈现显著增加趋势;血炎性细胞数和血清炎性因子表达明显降低[WBC:(11.83±0.74)×10^9/L比(9.51±0.90)×10^9/L,P=0.029;N%:(79.11±1.51)%比(72.71±1.16)%,P=0.041;CRP:(85.15±8.42)mg/L比(63.96±5.72)mg/L,P=0.001;PCT:(6.43±0.47)μg/L比(4.83±0.39)μg/L,P=0.013]。第14天,与对照组比较,研究组患者病情危重程度明显好转,GCS评分升高[(8.69±0.41)分比(9.52±0.59)分,P=0.038)],APACHEⅡ评分降低[(14.74±1.01)分比(12.68±0.89)分,P=0.049);患者机械通气时间[(13.23±1.17)d比(10.88±1.24)d,P=0.024]和住院天数[(23.29±2.45)d比(18.42±1.96)d,P=0.012]均减少;14d内撤机成功率提高[24/32(75%)比27/32(84%),P=0.030]。结论对于重型颅脑损伤机械通气患者,含ω-3PUFA肠内免疫营养支持能够有效降低呼吸机相关性肺炎发生率,抑制全身炎症反应和减轻感染危重程度,进而改善患者病情及预后,值得临床推广使Objective To investigate the effects of enteral immunonutrition supplemented with omega-3 polyunsaturated fatty acid(ω-3 PUFA)on the incidences and severity of ventilator associated pneumonia complications,inflammatory response,and the prognosis in patients with severe traumatic brain injury(sTBI)undergoing ventilator therapy.Methods From January 2015 to June 2017,64 patients of sTBI were selected and randomly divided into experimental group(ω-3 PUFA,n=32)and control group(n=32).White blood cells(WBC)and the proportion of neutrophils(N%)were evaluated by cell analyzer.Meanwhile,the serum levels of C-reactive protein(CRP)and procalcitonin(PCT)were tested with enzyme linked immunosorbent assay.After 14-days treatment,the Glasgow coma scale(GCS)score,APACHE Ⅱ score,clinical pulmonary infection score(CPIS),pulmonary function and prognoses were also compared between the two groups.Results As compared with the control group,the experimental group had lower incidences of ventilator associated pneumonia(66% vs.56%,P=0.048),reduced degree of lung infection and lower CPIS(8.25±0.60 vs.7.47±0.53);higher lung function indexes[FVC:(2.89±0.19)L vs.(3.46±0.22)L,P=0.010;FEV1:(2.35±0.16)L vs.(2.84±0.24)L,P=0.040;FEV1/FVC %:(49.11±3.34)% vs.(56.00±2.64)%,P=0.038)];lower serum levels of inflammatory responses [WBC:(11.83±0.74)×10^9/L vs.(9.51±0.90)×10^9/L,P=0.029;N%:(79.11±1.51)% vs.(72.71±1.16)%,P=0.041;CRP:(85.15±8.42)mg/L vs.(63.96±5.72)mg/L,P=0.001;PCT:(6.43±0.47)μg/L vs.(4.83±0.39)μg/L,P=0.013]14 days after enteral immunonutrition supplemented with ω-3 PUFA.As compared with the control group,the experimental group received better prognosis with GCS scores increasing(8.69±0.41 vs.9.52±0.59,P=0.038),APACHE Ⅱ scores decreasing(14.74±1.01 vs.12.68±0.89,P=0.049),the time of mechanical ventilation [(13.23±1.17)d vs.(10.88±1.24)d,P=0.024] and the hospitalization days [(23.29±2.45)d vs.(18.42±1.96)d,P=0.012] reduced on the 14th day,mechanical ventilation withdraw rate within 14 days increasing [24/32

关 键 词：颅脑损伤 不饱和脂肪酸 呼吸机相关性肺炎 炎性反应 

分 类 号：R651.15[医药卫生—外科学] R563.1[医药卫生—临床医学]