不同肠内营养制剂对感染性休克患者营养状态及肠黏膜屏障功能的影响  

Comparison of effects of different enteral nutritional agents on nutritional status and intestinal mucosal barrier in patients with septic shock

作　　者：管智慧[1] 肖小荣 周灵敏[1] 邵飞飞[1] 张倩 罗金明[1] Guan Zhihui;Xiao Xiaorong;Zhou Lingminy;Shao Feifei;Zhang Qian;Luo Jinming(Department of Intensive Care Unit,the First People's Hospital of Taizhou,Taizhou 318020,Zhejiang,China)

机构地区：[1]台州市第一人民医院重症医学科,浙江台州318020

出　　处：《中国中西医结合急救杂志》2019年第5期603-607,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的观察不同肠内营养(EN)制剂瑞能和瑞素对感染性休克患者营养状态及肠黏膜屏障功能的影响.方法选择台州市第一人民医院重症医学科2017年5月至2018年5月收治的感染性休克患者112例,采用随机对照单盲的方法将患者分为瑞能组及瑞素组,每组56例.两组患者入院后均参照"拯救脓毒症运动"(SSC)2016年版感染性休克指南给予治疗,两组营养支持方案均为EN,其中瑞能组给予富含鱼油的瑞能乳剂;瑞素组给予标准EN制剂瑞素,两组均连用7 d.比较两组营养状态、炎症指标、免疫功能、肠黏膜屏障、胃肠道症状及预后的差异.结果两组EN后白蛋白(Alb)、前白蛋白(PA)、转铁蛋白(TRF)和免疫球蛋白(IgA、IgG)、人白细胞DR抗原(HLA-DR)以及D-乳酸均较治疗前升高,至EN 7 d达峰值,且瑞能组Alb、PA、TRF、IgA、IgG、HLA-DR均高于瑞素组〔Alb(g/L):34.43±5.81比33.59±5.34,PA(mg/L):269.83±47.56比252.67±41.92,TRF(g/L):3.43±0.64比3.32±0.81,IgA(mg/L):159.45±34.56比143.31±33.81,IgG(mg/L):4 947.68±871.66比4 583.75±841.54,HLA-DR :(68.22±9.11)%比(62.21±9.69)%〕,D-乳酸明显低于瑞素组(mg/L :30.42±6.79比33.34±7.31).两组EN后肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、降钙素原(PCT)、内毒素和二胺氧化酶均逐渐降低,至EN 7 d达最低水平,且瑞能组上述指标均显著低于瑞素组〔TNF-α(ng/L):95.43±20.69 比 109.59±23.45,CRP(mg/L):21.33±16.35 比 32.36±17.83,PCT(μg/L):1.24±1.21比4.18±1.32,内毒素(U/L):10.32±2.31比11.54±2.69,二胺氧化酶(g/L):19.45±8.49比25.47± 9.41〕.瑞能组胃潴留、腹泻及下消化道麻痹发生率显著低于瑞素组〔胃潴留:14.29%(8/56)比32.14%(18/56),腹泻:12.50%(7/56)比35.71%(20/56),下消化道麻痹:7.14%(4/56)比23.21%(13/56)〕,住院时间较瑞素组显著缩短(d :18.77±5.08比21.71±6.67,P<0.05);但瑞能组和瑞素组病死率比较差异无统计学意义〔14.29% (8/56)比21.43%(12/56),P>0.05〕.结论瑞能可更加有Objective To investigate the effects of different early enteral nutrient(EN)emulsions of TPF-T and TP on nutritional status and intestinal mucosal barrier in patients with septic shock.Methods From May 2017 to May 2018,112 patients with septic shock were continuously enrolled in the Department of Intensive Care Unit of the First People's Hospital of Taizhou,and they were randomly divided into a TPF-T group and TP group,each group with 56 cases.After admission,the patients in both groups were all treated according to the 2016 Saving Sepsis Campaign(SSC)Guidelines for septic shock.Both groups were supported with EN,TPT-T group was given TPF-T EN emulsion rich in fish oil,while TP group was supported with standard TP EN emulsion,and the therapeutic course was consecutive 7 days in both groups.The differences in nutritional status,inflammatory response,immune function,intestinal mucosal barrier,gastrointestinal symptoms and prognosis were compared between the two groups.Results After EN,the nutrition indicators such as albumin(Alb),prealbumin(PA),transferrin(TRF)and immune indexes(IgA,IgG),human leukocyte DR antigens(HLA-DR)and D-lactic acid were increased in both groups,reaching the peaks on the 7th day after EN application,Alb,PA,TRF,IgA,IgG,HLA-DR in the TPF-T group were significantly higher than those in the TP group[Alb(g/L):34.43±5.81 vs.33.59±5.34,PA(mg/L):269.83±47.56 vs.252.67±41.92,TRF(g/L):3.43±0.64 vs.3.32±0.81,IgA(mg/L):159.45±34.56 vs.143.31±33.81,IgG(mg/L):4947.68±871.66 vs.4583.75±841.54,HLA-DR:(68.22±9.11)%vs.(62.21±9.69)%],and after EN,the D-lactic acid in the TPF-T group was significantly lower than that in the TP group(mg/L:30.42±6.79 vs.33.34±7.31).The inflammatory indicators of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),procalcitonin(PCT),endotoxin and diamine oxidase(DAO)were all gradually reduced in two groups,reached the lowest levels on the 7th day after EN application,and all the above-mentioned indicators in the TPF-T group were significantly lower than those in

关 键 词：感染性休克 肠内营养 瑞能 瑞素 营养状态 肠黏膜屏障 

分 类 号：R73[医药卫生—肿瘤]