不同肠内营养制剂对脓毒症患者的临床效果观察  

Clinical observation on application of different enteral nutrition preparations in patients with sepsis

作　　者：赵辉[1] 应华良 王佳婷 干鹏程 张超[1] Zhao Hui;Ying Hualiang;Wang Jiating;Gan Pengcheng;Zhang Chao(Department of Critical Care Medicine,Taizhou Hospital of Zhejiang Province,Taizhou Enze Medical Center Group Enze Hospital,Taizhou 318050,Zhejiang,China)

机构地区：[1]浙江省台州医院台州恩泽医疗中心(集团)恩泽医院重症医学科,浙江台州318050

出　　处：《中国中西医结合急救杂志》2022年第4期430-434,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省台州市科技计划项目(20ywa50)。

摘　　要：目的观察不同肠内营养(EN)制剂对脓毒症患者的血糖变异指标、炎症指标、营养指标、肠黏膜屏障指标、胃肠道不良反应和临床预后的影响。方法选择浙江省台州医院重症医学科2020年1月至2021年6月收治74例成人脓毒症患者,其中使用EN乳剂TPF-D 36例,使用EN乳剂TP 38例,所有患者在收住重症监护病房(ICU)后48 h内开始使用EN治疗,营养支持热量目标为104.6~125.5 kJ·kg^(-1)·d^(-1),蛋白目标为1.2~1.5 g·kg^(-1)·d^(-1)。收集两组患者的临床资料,入ICU 1、3、7 d的血糖平均值(GLUave)、最大血糖变异幅度(LAGE)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、降钙素原(PCT)、前白蛋白(PA)、转铁蛋白(TF)、D-乳酸、二胺氧化酶(DAO)、胃肠道不良反应和机械通气(MV)时间、ICU住院时间、总住院时间等指标;比较两种EN制剂的治疗效果。结果两组患者一般临床资料、1 d的GLUave、LAGE、血清TNF-α、CRP、PA、TF、D-乳酸、DAO水平及1、3、7 d血清PCT水平比较差异均无统计学意义(均P>0.05)。TPF-D组3 d和7 d GLUave低于TP组(mmol/L:3 d为9.77±1.88比10.76±2.00,7 d为9.71±1.58比10.55±1.81,均P<0.05)。TPF-D组3 d LAGE低于TP组(mmol/L:4.82±0.94比5.46±1.56,P<0.05)。TPF-D组3 d和7 d血清CRP水平均低于TP组(mg/L:3 d为41.46±23.90比53.26±22.95,7 d为21.92±13.62比30.05±16.42,均P<0.05)。TPF-D组7 d血清TNF-α水平低于TP组(ng/L:13.71±9.22比18.03±7.73,P<0.05)。TPF-D组3 d和7 d血清PA水平均高于TP组(mg/L:3 d为22.20±3.61比20.39±3.62,7 d为25.44±3.33比23.79±3.28,均P<0.05)。TPF-D组7 d血清TF水平高于TP组(mg/L:29.59±5.24比26.73±4.90,P<0.05)。TPF-D组7 d血清D-乳酸水平均低于TP组(μg/L:13.92±8.79比19.07±9.05,P<0.05)。TPF-D组7 d血清DAO水平均低于TP组(U/L:2.65±0.94比3.20±1.09,P<0.05)。两组患者食物不耐受综合征、腹腔高压、胃潴留发生率比较差异均无统计学意义(均P>0.05),TPF-D组腹泻和下消化道麻痹发生率低于TP组Objective To observe the effects of enteral nutrition(EN)preparations with different components on blood glucose variation,inflammatory reaction,nutritional status index,intestinal mucosal barrier,gastrointestinal symptoms and clinical prognosis in patients with sepsis.Methods From January 2020 to June 2021,a total of 74 adult patients with sepsis admitted to the department of critical care medicine of Taizhou Hospital of Zhejiang Province were enrolled.All the patients had received EN,36 cases of these patients were fed with EN emulsion TPF-D,and the other 38 patients were fed with EN emulsion TP.The EN support began within 48 hours after the patients were admitted to intensive care unit(ICU).The energy and protein intake target were 104.6-125.5 kJ·kg^(-1)·d^(-1) and 1.2-1.5 g·kg^(-1)·d^(-1),respectively.The clinical data,average blood glucose(GLUave),largest amplitude of glycemic excursions(LAGE),the levels of serum tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),procalcitonin(PCT),prealbumin(PA),transferrin(TF),D-lactic acid,diamine oxidase(DAO)were recorded on the 1st,3rd,and 7th day after admission to ICU,gastrointestinal symptoms,the duration of mechanical ventilation(MV),the length of ICU and hospital stay were compared between the two groups.Results There were no statistical differences in clinical data,GLUave,LAGE,the serum TNF-α,CRP,PA,TF,D-lactic acid and DAO level of the 1st day and the PCT level of the 1st,3rd,and 7th day after admission to ICU between two groups(all P>0.05).On the 3rd and 7th day,the GLUave in the TPF-D group were lower than those in the TP group(mmol/L:9.77±1.88 vs.10.76±2.00 on 3rd day,9.71±1.58 vs.10.55±1.81 on 7th day,both P<0.05).On the 3rd day,the LAGE in the TPF-D group was lower than that in the TP group(mmol/L:4.82±0.94 vs.5.46±1.56,P<0.05).On the 3rd and 7th day,the levels of serum CRP in the TPF-D group were lower than those in the TP group(mg/L:41.46±23.90 vs.53.26±22.95 on the 3rd day,21.92±13.62 vs.30.05±16.42 on the 7th day,both P<0.05).On the

关 键 词：脓毒症 肠内营养 血糖变异 预后 

分 类 号：R459.7[医药卫生—急诊医学]