不同营养支持方案对重症CAP患者肠道菌群、营养指标及远期预后的影响  

Effects of Different Nutritional Support Schemes on Intestinal Flora,Nutritional Indicators and Long-term Prognosis in Patients with Severe CAP

作　　者：李珊珊 奚峰 冯慧丽 顾文超 LI Shanshan;XI Feng;FENG Huili;GU Wenchao(Department of Respiratory Medicine,Shanghai Pudong New Area People′s Hospital Affiliated to Shanghai University of Medicine and Health Sciences,Shanghai 201200,China)

机构地区：[1]上海健康医学院附属上海市浦东新区人民医院呼吸内科,上海201200

出　　处：《中国医药导刊》2018年第11期652-655,共4页Chinese Journal of Medicinal Guide

基　　金：浦东新区卫生系统重点学科建设资助项目(项目编号:PWZxk2017-24;项目名称:Lnc RNA TUG1上调在COPD气道重塑中的作用及机制研究)

摘　　要：目的:研究不同营养支持方案对重症社区获得性肺炎(CAP)患者肠道菌群、营养指标及远期预后的影响。方法:选取2016年1月至2017年12月在我院接受治疗的重症CAP患者62例作为研究对象,采用随机数字表法将其分为对照组和观察组,每组各31例。对照组患者给予常规肠内营养支持,观察组患者给予肠内免疫微生态营养支持。比较两组患者的炎性因子、肠道菌群、营养指标和预后等。结果:治疗前两组患者的营养指标相近(P> 0. 05),治疗后两组患者的前白蛋白(PAB)和转铁蛋白(TRF)水平均升高,观察组患者的PAB和TRF水平均高于对照组(P <0. 05)。治疗后两组患者的白细胞介素-6(IL-6)、超敏C-反应蛋白(hs-CRP)和肿瘤坏死因子-α(TNF-α)水平均明显下降,观察组患者的IL-6、hs-CRP和TNF-α水平均低于对照组(P <0. 05)。两组患者发病10 d后,观察组患者大便菌群涂片检查菌群失调率为3. 23%(1/31),对照组患者大便菌群涂片检查菌群失调率为19. 35%(6/31),差异有统计学意义(χ~2=4. 026,P=0. 045)。观察组患者的机械通气时间和ICU入住时间均短于对照组(P <0. 05),两组患者的抗生素使用时间及并发症发生率相近(P> 0. 05)。结论:早期肠内营养支持可以改善重症CAP患者的预后,降低炎性因子水平,而肠内免疫微生态营养支持能够更好地改善重症CAP患者的营养状态,降低炎性因子水平,有助于改善肠道微生态环境,从而改善患者预后。Objective:To study the effects of different nutritional support schemes on intestinal flora,nutritional indicators and long-term prognosis in severe community acquired pneumonia(CAP)patients.Methods:62 patients with severe CAP who received treatment in our hospital were selected from January 2016 to December 2017.They were divided into the control group and the observation group using random number table,each group had 31 cases.The control group was given routine enteral nutrition support,and the observation group was given enteral immune microecological nutrition support.Compared the inflammatory factors,intestinal flora,nutritional indicators and prognosis between the two groups.Results:The nutritional indicators of the two groups were similar before treatment(P>0.05).The level of TRF and PAB in the two groups increased after treatment,and the level of PAB and TRF in the observation group was higher than those of the control group(P<0.05).After treatment,the levels of IL-6,hs-CRP and TNF-αin the two groups were decreased,while the levels of IL-6,hs-CRP and TNF-αin the observation group were lower than those of the control group(P<0.05).10 d after the onset,the bacterial flora imbalance rate was 3.23%(1/31)in the observation group and 19.35%(6/31)in the control group.The difference was statistically significant(χ2=4.026,P=0.045).The time of mechanical ventilation and ICU stay in the observation group were shorter than those of the control group(P<0.05).The time of antibiotic use and the incidence of complications in the two groups were similar(P>0.05).Conclusion:Early enteral nutrition support can obviously improve the prognosis of severe CAP patients and reduce the level of inflammatory factors.Enteral immune microecological nutrition support can better improve the nutritional status of severe CAP patients,reduce the level of inflammatory factors,improve the intestinal microecological environment and improve the prognosis of patients.

关 键 词：重症社区获得性肺炎 营养支持 肠内免疫微生态营养 肠道菌群 

分 类 号：R576[医药卫生—消化系统] R459.3[医药卫生—内科学]