补充性肠外营养治疗对重症病毒性脑炎患儿免疫水平及医院感染的影响  

Effect of supplemental parenteral nutrition on immune function and nosocomial infection in children with severe viral encephalitis

作　　者：陈锋[1] 张芙蓉[1] 陈洋[1] 许瑜 CHEN Feng;ZHANG Furong;CHEN Yang;XU Yu(Intensive Care Unit,Wuhan Children′s Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430016,China;Department of Nosocomial Infection Management,Wuhan Children′s Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院重症医学科,武汉430016 [2]华中科技大学同济医学院附属武汉儿童医院院感科,武汉430016

出　　处：《重庆医学》2019年第15期2554-2557,共4页Chongqing medicine

基　　金：湖北省武汉市卫生和计划生育委员会医疗卫生科研项目(WX14B23)

摘　　要：目的比较肠内营养(EN)与补充性肠外营养(SPN)治疗对重症病毒性脑炎(SVE)患儿免疫水平及医院感染的影响。方法回顾性分析2012年1月至2017年12月该院重症医学科收治的126例SVE患儿临床资料,根据营养途径分为SPN组(n=59)与EN组(n=67),SPN组采用EN联合SPN进行营养支持,EN组采取留置胃管的方式进行EN支持,比较两组患者的营养状况、免疫水平和医院感染状况。结果营养干预后第14天SPN组血清总蛋白(TP)水平,干预后第7、14天SPV组转铁蛋白(TRF)水平较EN组升高,差异均有统计学意义(t=3.12、2.08、2.29,P<0.05)。干预后第14天,两组患儿外周血CD3^+、CD4^+、CD19^+细胞百分比、CD4^+/CD8^+比值及IgG、IgA、IgM水平均较干预前增加,差异有统计学意义(P<0.05)。营养干预后,SPN组CD4^+、CD19^+细胞百分比高于EN组,差异均有统计学意义(P<0.05)。SPN组患者机械通气时间、儿科重症监护室(PICU)住院时间低于EN组,差异均有统计学意义(P<0.01)。EN组医院感染率(17.91%)低于SPN组(33.90%),差异有统计学意义(P<0.05)。结论SPN治疗可以促进SVE患儿的免疫功能恢复,提高临床疗效,但较EN增加了患儿发生医院感染的风险。Objective To compare the effects of enteral nutrition(EN)and supplemental parenteral nutrition(SPN)on immune function and nosocomial infection in children with severe viral encephalitis(SVE).Methods The clinical data of 126 children with SVE admitted to the Intensive Care Unit in this hospital from January 2012 to December 2017 were retrospectively analyzed.According to the nutritional pathway,patients were divided into the SPN group(n=59)and the EN group(n=67).The EN group used indwelling gastric tube for EN support,while the SPN group received EN combined with SPN for nutrition support.The nutritional status,immune function and occurence of nosocomial infection were compared between the two groups.Results In the SPN group,the serum level of total protein(TP)on the 14th day after nutrition intervention and the level of transferrin(TRF)on the 7th and 14th day after nutrition intervention were higher than those in the EN group,and the differences were statistically significant(t=3.12,2.08,2.29,P<0.05).On the 14th day after intervention,the percentage of CD3^+,CD4^+,CD19^+cells,CD4^+/CD8^+ratio,and IgG,IgA and IgM levels in peripheral blood in the two groups were higher than those before intervention,and the differences were statistically significant(P<0.05).After nutrition intervention,the percentages of CD4^+and CD19^+cells in the SPN group were higher than those in the EN group,and the differences were statistically significant(P<0.05).The mechanical ventilation time and PICU hospitalization time in the SPN group were shorter than those in the EN group,and the differences were statistically significant(P<0.01).The nosocomial infection rate in the EN group(17.91%)was lower than that in the SPN group(33.90%),and the difference was statistically significant(P<0.05).Conclusion SPN treatment can promote the recovery of the immune func-tion,and improve the clinical outcomes in children with SVE,but increase the risk of nosocomial infection.

关 键 词：补充性肠外营养 脑炎 病毒性 免疫功能 医院感染 

分 类 号：R723.2[医药卫生—儿科]