早期肠内营养在重症新冠肺炎病人炎症因子及临床预后中的研究  

Effects of early enteral nutrition to inflammatory cytokines and clinical prognosis in patients with critical COVID-19

作　　者：肖刘牛 冉晓[1] 钟燕霞 乐悦 李树生[1] XIAO Liu-niu;RAN Xiao;ZHONG Yan-xia;LE yue;LI Shu-sheng(Department of Intensive Care Unit,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technolog,Wuhan 430030,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属同济医院重症医学科,湖北武汉430030

出　　处：《肠外与肠内营养》2021年第2期65-71,共7页Parenteral & Enteral Nutrition

基　　金：国家自然科学基金面上项目(81770413)。

摘　　要：目的:探讨早期肠内营养(EEN)在重症新冠肺炎病人炎症因子及临床预后中的研究价值。方法:回顾性搜集从2020年1月至2020年4月,华中科技大学同济医学院附属同济医院收治,确诊为重症新冠肺炎的病人。其中共103例接受了肠内营养(EN)治疗,按照EN的起始时间点不同,分为早期肠内营养组(EEN,EN起始时间≤2 d)和晚期肠内营养组(LEN,EN起始时间≥3 d)。比较两组病人血清炎症因子、9个月整体生存率、整体住院时间、重症监护室(ICU)住院时间以及胃肠道不耐受的发生率。结果:EEN组共58例病人,LEN组共45例病人。两组病人入院时基线临床资料未见明显差异(P> 0.05)。EEN组平均起始时间间隔为1 d,LEN组平均起始时间间隔为4 d。入院时两组病人的炎症因子无统计学差异(P> 0.05),至接受EN治疗后第3天,EEN组炎症因子(C反应蛋白,降钙素原,血沉,白介素-6,白介素-8,白介素-10,肿瘤坏死因子-a)浓度显著低于LEN组(P <0.05)。虽然两组病人9个月整体生存率(P=0.518)无显著差异,但是EEN组的整体住院时间(P <0.0001)和ICU住院时间(P <0.0001)显著缩短,并且两组病人胃肠道不耐受(P=0.386)的发生率无明显差异。受试者工作曲线(ROC)提示病人年龄(P=0.005)及入院时降钙素原水平(P=0.017)可预测远期整体存活率。多因素Cox回归分析发现病人年龄(P=0.041)是重症新冠肺炎临床预后的独立危险因素。结论:EEN的运用,可以显著降低重症新冠肺炎病人的炎症水平,缩短病人的整体住院时间及ICU住院时间,而对远期临床预后无明显影响。Objective:To investigate the effects of early enteral nutrition(EEN)to inflammatory factors and clinical prognosis in patients with critical Coronavirus Disease 2019(COVID-19).Methods:From January 2020 to April 2020,patients with confirmed critical COVID-19 in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were retrospectively reviewed.A total of 103 cases who received enteral nutrition(EN)therapy were included,and they were divided into two groups according to EN initiation time.Patients who accepted EN therapy within two days after admission were classified into EEN group,while others(≥3 days)were included into late enteral nutrition(LEN)group.Serum inflammatory cytokines,9-month overall survival,in hospital stay length,Intensive Care Unit(ICU)stay length and gastrointestinal intolerance were compared between the two groups.Results:58 and 45 patients were involved in EEN group and LEN group,respectively.Basic demographic characteristics were comparable between the two groups at admission(P>0.05).The average time interval from admission for EEN group was one day,while for LEN group was four days.The inflammatory cytokines showed no significant difference at baseline(P>0.05).Three days after EN therapy,the serum cytokines,such as C Reaction Protein(CRP),Procalcitonin(PCT),Erythrocyte Sedimentation Rate(ESR),Interleukin-6(IL-6),Interleukin-8(IL-8),Interleukin-10(IL-10)and Tumor Necrosis Factor-a(TNF-a),were significant lower in EEN group(P<0.05).Although there were no difference for 9-month overall survival between the two groups(P=0.518),EEN group presented a significantly shorter in-hospital stay length(P<0.0001)as well as ICU stay length(P<0.0001),without affecting the incidence rate of gastrointestinal intolerance(P=0.386).Receiver Operation Curve(ROC)suggested that the age(P=0.005)and the level of PCT on admission(P=0.017)could predict the long-term overall survival.Besides,the age(P=0.041)was an independent risk factor for clinical prognosis by Cox mul

关 键 词：早期肠内营养 炎症因子 9个月整体生存率 住院时长 胃肠道不耐受 

分 类 号：R459.3[医药卫生—治疗学] R563.1[医药卫生—临床医学]