短肽型肠内营养配比方案在重型脑损伤患者中的应用  

Application of short peptide enteral nutrition formula in patients with severe brain injury

作　　者：吴杭捷 楼滟 张锦丽 WU Hangjie;LOU Yan;ZHANG Jinli(Department of Critical Care Medicine,Hangzhou Hospital,Zhejiang Medical and Health Group,Hangzhou 310022,China)

机构地区：[1]浙江省医疗健康集团杭州医院重症医学科,浙江杭州310022

出　　处：《中国现代医生》2022年第34期14-18,共5页China Modern Doctor

基　　金：杭州市医药卫生科技项目(B20200493)。

摘　　要：目的探究短肽型肠内营养(enteral nutrition,EN)配比方案对重型脑损伤(severe brain injury,SBI)患者肠黏膜和免疫功能的影响。方法选取2019年1月至2022年1月浙江省医疗健康集团杭州医院收治的96例SBI患者,采用随机数字表法将其分为观察组和对照组,每组各48例。对照组患者采用短肽型:整蛋白型=1:1的EN配比方案,观察组患者采用短肽型:整蛋白型=4:1的EN配比方案,两组患者均连续治疗7d。比较两组患者的营养状况、肠黏膜功能、免疫功能、肠道耐受情况及氧合指数,并统计两组患者的重症监护病房(intensive care unit,ICU)住院时间、EN达标时间及机械通气时间。结果治疗后,两组患者的白蛋白(albumin,ALB)、总蛋白(total protein,TP)、前白蛋白(prealbumin,PA)、免疫球蛋白(immunoglobulin,Ig)G、IgA、IgM水平及氧合指数均显著高于本组治疗前,尿乳果糖与甘露醇之比(lactulose/mannitol,L/M)、D-乳糖水平均显著低于本组治疗前(P<0.05);观察组患者的ALB、TP、PA、IgG、IgA、IgM水平及氧合指数均显著高于对照组,尿L/M、D-乳糖水平均显著低于对照组(P<0.05);观察组患者的肠道不耐受率显著低于对照组(10.42%vs 29.17%,P<0.05)。观察组患者的ICU住院时间、EN达标时间、机械通气时间均显著短于对照组(P<0.05)。结论与短肽型:整蛋白型=1:1的EN配比方案比较,短肽型:整蛋白型=4:1的EN配比方案在改善SBI患者营养功能、肠黏膜功能及免疫功能方面效果更优,同时能够提高肠道耐受度,加速患者康复。Objective To explore the effect of short peptide enteral nutrition(EN)formula on intestinal mucosa and immune function in patients with severe brain injury(SBI).Methods A total of 96 SBI patients admitted to Hangzhou Hospital,Zhejiang Medical and Health Group from January 2019 to January 2022 were selected and divided into observation group and control group by random number table method,48 cases in each group.Patients in control group was treated with short peptide type:whole protein type=1:1 EN ratio scheme,patients in observation group was treated with short peptide type:whole protein type=4:1 EN ratio scheme,and both groups were treated for 7 days.The nutritional status,intestinal mucosal function,immune function,intestinal tolerance and oxygenation index of the two groups were compared,and the length of stay in intensive care unit(ICU),EN compliance time and mechanical ventilation time of the two groups were counted.Results After treatment,the levels of albumin(ALB),total protein(TP),prealbumin(PA),immunoglobulin(Ig)G,IgA,IgM and oxygenation index in two groups were significantly higher than before treatment,the ratio of lactulose/mannitol(L/M)and the level of D-lactose were significantly lower than those before treatment(P<0.05).The levels of ALB,TP,PA,IgG,IgA,IgM and oxygenation index in observation group were significantly higher than those in control group,while urinary L/M and D-lactose levels were significantly lower than those in control group(P<0.05).The intestinal intolerance rate in observation group was significantly lower than that in control group(10.42%vs 29.17%,P<0.05).The length of ICU stay,EN compliance time and mechanical ventilation time in observation group were significantly shorter than those in control group(P<0.05).Conclusion Compared with short peptide type:whole protein type=1:1 EN ratio scheme,the short peptide type:whole protein type=4:1 EN ratio scheme had better effects in improving the nutritional function,intestinal mucosal function and immune function of SBI patients,and coul

关 键 词：短肽型肠内营养 重型脑损伤 肠黏膜 免疫功能 

分 类 号：R641[医药卫生—外科学]