早期完全肠内营养对肿瘤并发脓毒症患者的肠黏膜屏障保护作用的研究  

Protective effect of early total enteral nutrition on enteral mucosalbarrier in patients with tumor complicated with sepsis

作　　者：张明 童静 高天巍[1] 徐雁[1] 陈欣[1] 汪建英[1] 余晓婷[1] 章建芳[1] ZHANG Ming;TONG Jing;GAO Tianwei(Department of Intensive Care Unit,Hangzhou Cancer Hospital,Hangzhou 310002,China)

机构地区：[1]杭州市肿瘤医院重症医学科,浙江杭州310002

出　　处：《全科医学临床与教育》2018年第6期647-651,共5页Clinical Education of General Practice

摘　　要：目的探讨早期完全肠内营养对肿瘤并发脓毒症患者肠血清标志物的影响,并分析肠血清标志物与预后的关系。方法将60例肿瘤并发脓毒症患者随机分为早期完全肠内营养(TEN)组和在肠内营养基础上辅助肠外营养(SPN)组,每组各30例。TEN组患者在胃肠功能能够耐受的情况下逐渐增加EN的喂养量,并于7 d内达到目标热卡量。SPN组患者依据TEN组方案支持3 d后开始辅助肠外营养使其达到目标热卡量。分别于治疗前、治疗后3 d、治疗后7 d观察两组患者白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、肠脂肪酸结合蛋白(IFABP)、D-乳酸以及瓜氨酸水平变化。并记录患者机械通气时间、ICU住院时间及28 d病死率情况。结果组内比较,SPN组和TEN组治疗后7 d的IL-6、TNF-α、血浆IFABP、D-乳酸水平均明显低于治疗前和治疗后3 d,治疗后3 d的IL-6、TNF-α、血浆IFABP、D-乳酸水平亦明显低于治疗前,而治疗后7 d的瓜氨酸水平明显高于治疗前和治疗后3 d,治疗后3 d的瓜氨酸水平亦明显高于治疗前,差异均有统计学意义(P均<0.05)。组间比较,与SPN组比较,TEN组治疗后3 d及7 d的血浆IL-6、TNF-α、血浆IFABP及D-乳酸均明显降低(t分别=5.56、5.13;4.00、3.43;2.83、7.88;4.23、5.71,P均<0.05),而瓜氨酸水平明显升高(t分别=-2.43、-4.30,P均<0.05)。两组患者机械通气时间、住ICU时间及28 d病死率比较,差异均无统计学意义(t分别=1.29、1.98,χ2=0.30,P均>0.05)。患者入科时血浆IFABP、瓜氨酸及D-乳酸水平与患者机械通气时间、住ICU时间及28 d病死率无明显的相关性(r分别=0.02、-0.04、0.12;0.14、-0.08、0.12;0.22、-0.12、0.07,P均>0.05)。结论早期完全肠内营养可以改善脓毒症患者的肠血清标志物水平,具有保护肠黏膜屏障作用;但并不能降低脓毒症患者机械通气时间、住ICU时间以及28 d病死率。Objective To investigate the effect of early total enteral nutrition on intestinal serum markers in patients with tumor complicated with sepsis and analyze the relationship between intestinal serum markers and prognosis. Methods Totally 60 cases of tumor complicated with sepsis were randomly divided into early total enteral nutrition（TEN）group and supplementary parenteral nutrition（SPN）group with 30 cases in each. The TEN group gradually increased EN feeding volume when gastrointestinal function was tolerable till reaching the target calorie volume within 7 days. Patients in SPN group began to receive parenteral nutrition after receiving EN for 3 days till achieving the target calorie volume. The levels of interleukin-6（IL-6）,tumor necrosis factor（TNF）- alpha,intestinal fatty acid binding protein（IFABP）,D-lactic acid and citrulline were observed before treatment,3 days and 7 days after treatment. Mechanical ventilation time,ICU hospitalization time and 28d mortality were recorded. Results The levels of IL-6,TNF-α,IFABP and D-lactate on 7 days after treatment of SPN group and TEN group were significantly lower than those before treatment and 3 days after treatment.The levels of IL-6,TNF-α,IFABP and D-lactate on 3 days after treatment of SPN group and TEN group were significantly lower than those before treatment. While the level of citrulline on 7 days after treatment was significantly higher than that before treatment and 3 days after treatment,and the level of citrulline on 3 days after treatment was significantly higher than that before treatment（P〈0.05）. Compared with SPN group,the levels of IL-6,TNF-α,IFABP and D-lactate of TEN group were significantly lower on 3 days and 7 days after treatment（t= 5.56,5.13,4.00,3.43,2.83,7.88,4.23,5.71,P〈0.05）,while the levels of citrulline were significantly higher（t=-2.43,-4.30,P〈0.05）. There were no significant differences in mechanical ventilation time,ICU time and 28-day mortality between the two groups（t=1.29,1.98,χ2= 0.30,P�

关 键 词：脓毒症 完全肠内营养 白介素-6 肿瘤坏死因子-α 肠脂肪酸结合蛋白 瓜氨酸 D-乳酸 

分 类 号：R459.7[医药卫生—急诊医学] R730.5[医药卫生—治疗学]