早期肠内营养支持对ICU脑卒中患者免疫功能及肠道黏膜屏障的影响  

Effect of Early Enteral Nutrition Support on Immune Function and Intestinal Mucosal Barrier of Stroke Patients in ICU

作　　者：李妍平[1] 李京辉 董小林[1] 魏欢[1] 李青芸[1] LI Yanping;LI Jinghui;DONG Xiaolin;WEI Huan;LI Qingyun(Department of Neurology,Yan'an Hospital Affiliated to Kunming Medical University,Kunming,Yunnan Province,650051 China;Department of critical care medicine,Yan'an Hospital Affiliated to Kunming Medical University,Kunming,Yunnan Province,650051 China)

机构地区：[1]昆明医科大学附属延安医院神经内科,云南昆明650051 [2]昆明医科大学附属延安医院重症医学科,云南昆明650051

出　　处：《系统医学》2021年第21期97-100,105,共5页Systems Medicine

基　　金：昆明市卫生科技人才培养项目暨“十百千”工程项目[2020-SW(后备)-16];昆明市卫生和计划生育委员会医药卫生科技计划项目(2020-03-07-111);昆明市卫生健康委员会卫生科研课题项目(2020-21-01-011);昆明市延安医院院内课题项目(yyky019-040)。

摘　　要：目的分析早期肠内营养支持对ICU脑卒中患者免疫功能及肠道黏膜屏障的影响。方法选取2019年2月—2020年2月该院收治的ICU脑卒中患者87例为研究对象。根据营养支持方案不同分为接受肠外营养支持干预对照组(n=43)和早期肠内营养支持干预观察组(n=44)。比较两组患者免疫功能、营养状态、通气时间、入住ICU时间、住院时间和肠道黏膜屏障指标。结果干预后,两组患者CD3^(+)和CD4^(+)/CD8^(+)较干预前升高,且观察组患者CD3^(+)(78.92±2.09)%和CD4^(+)/CD8^(+)(1.87±0.31)高于对照组,差异有统计学意义(t=18.899、3.351,P<0.05)。干预后,两组患者HSA、Hb水平较干预前升高;且观察组患者HAS(63.47±1.32)g/L、Hb(123.87±3.69)g/L高于对照组,差异有统计学意义(t=23.333、14.129,P<0.05)。观察组患者通气时间(7.18±1.38)d、入住ICU时间(7.29±2.14)d、住院时间(14.69±1.65)d均少于对照组,差异有统计学意义(t=11.912、9.935、25.039,P<0.05)。干预后,两组患者D-乳酸、DAO水平较干预前减少,其中观察组患者D-乳酸(6.71±2.05)mmol/mL、DAO(4.56±3.17)U/mL低于对照组(8.21±2.06)mmol/L、(7.17±3.16)U/mL,差异有统计学意义(t=3.404、3.787,P<0.05);双歧杆菌、乳酸菌及肠球菌数量明显高于对照组,差异有统计学意义(t=10.216、11.670、4.150,P<0.05)。结论早期肠内营养支持能显著改善ICU脑卒中患者免疫功能及肠道黏膜屏障功能,减少患者住院时间,改善机体营养状态,值得临床推广。Objective To analyze the effect of early enteral nutrition support on immune function and intestinal mucosal barrier in ICU stroke patients.Methods 87 stroke patients in ICU treated in the hospital from February 2019 to February 2020 were selected as the research objects.According to different nutritional support programs,they were divided into a control group receiving parenteral nutrition support intervention(n=43)and an early enteral nutrition support intervention observation group(n=44).The immune function,nutritional status,ventilation time,ICU stay,hospital stay and intestinal mucosal barrier indexes were compared between the two groups.Results After the intervention,the CD3^(+) and CD4^(+)/CD8^(+) of the two groups were higher than before the intervention,and the CD3^(+)(78.92±2.09)% and CD4^(+)/CD8^(+)(1.87±0.31)of the observation group were higher than those of the control group,and the difference was statistically significant(t=18.899,3.351,P<0.05).After the intervention,the levels of HSA and Hb in the two groups were higher than before the intervention;and the HAS(63.47±1.32)g/L and Hb(123.87±3.69)g/L of the observation group were higher than those in the control group,and the difference was statistically significant(t=23.333,14.129,P<0.05).In the observation group,the ventilation time(7.18±1.38)d,ICU stay(7.29±2.14)d,and hospitalization time(14.69±1.65)d were less than those in the control group,and the difference was statistically significant(t=11.912,9.935,25.039,P<0.05).After the intervention,the levels of D-lactic acid and DAO in the two groups were lower than before the intervention.Among them,the D-lactic acid(6.71±2.05)mmol/mL and DAO(4.56±3.17)U/mL of the observation group were lower than those of the control group(8.21±2.06)mmol/mL,(7.17±3.16)U/mL,and the difference was statistically significant(t=3.404,3.787,P<0.05);the numbers of bifidobacteria,lactic acid bacteria and enterococci were significantly higher than those of the control group,and the difference was statistically signi

关 键 词：早期肠内营养支持 ICU 脑卒中 免疫功能 肠道黏膜屏障 

分 类 号：R59[医药卫生—内科学]