不同营养支持方式对脓毒症患儿肠道屏障功能及肠源性感染指标的影响  

Effects of different nutritional support methods on intestinal barrier function and enterogenous infection indexes of children with sepsis

作　　者：陈朴 赵静[2] 吴琼 汤有才[2] 齐玉敏[1,2] CHEN Pu;ZHAO Jing;WU Qiong;TANG You-cai;QI Yu-min(Nanyang Central Hospital,Nanyang,Henan 473005,China)

机构地区：[1]南阳市中心医院儿科,河南南阳473005 [2]郑州大学第五附属医院儿科,河南郑州450000

出　　处：《中华医院感染学杂志》2023年第1期142-146,共5页Chinese Journal of Nosocomiology

基　　金：河南省重点研发推广专项(212102310033)。

摘　　要：目的 分析完全肠内营养(TEN)和辅助肠外营养(SPN)对脓毒症患儿肠道屏障功能和肠源性感染的影响。方法 选取2017年1月-2020年1月南阳市中心医院收治的48例脓毒症患儿,分为TEN组28例和SPN组20例,均接受营养支持治疗2周,比较两组患儿营养状态、肠道屏障功能及肠源性感染指标,分析两组患儿肠道菌群分布,随访28 d后患儿的预后情况。结果 接受营养支持治疗后,两组白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)水平均升高(P<0.05),且TEN组高于SPN组(P<0.05);TEN组内毒素(ET)、D-乳酸以及二胺氧化酶(DAO)水平均降低,且低于SPN组(P<0.05);TEN组白细胞计数(WBC),C-反应蛋白(CRP)以及降钙素原(PCT)水平降低,且低于SPN组(P<0.05);TEN组双歧杆菌和乳酸杆菌菌落数量显著升高、肠杆菌和肠球菌菌落数量显著降低(P<0.05),且TEN组双歧杆菌和乳酸杆菌菌落数量显著多于SPN组,肠杆菌和肠球菌菌落数量显著少于SPN组(P<0.05)。TEN组住院时间显著短于SPN组(P<0.05)。结论 与SPN比较,TEN更有利于改善脓毒症患儿的营养状态和肠道屏障功能,降低患儿发生肠源性感染的风险。OBJECTIVE To observe the effects of total enteral nutrition(TEN) and supplementary parenteral nutrition(SPN) on intestinal barrier function and enterogenous infection indexes of children with sepsis. METHODS A total of 48 children with sepsis who were treated in Nanyang Central Hospital from Jan 2017 to Jan 2020 were enrolled in the study and divided into the TEN group with 28 cases and the SPN group with 20 cases. Both groups were given nutrition support therapy for 2 weeks. The nutrition status, intestinal function indexes and enterogenous infection indexes were compared between the two groups of children. The intestinal flora of the children was observed, and a follow-up was conducted for prognosis of the children after 28 days. RESULTS The levels of albumin(ALB), prealbumin(PA) and transferrin(TRF) of the two groups were elevated after the nutrition support therapy(P<0.05), and the levels of above indexes of the TEN group were higher than those of the SPN group(P<0.05). The levels of endotoxin(ET), D-lactic acid and diamine oxidase(DAO) of the TEN group were reduced, and the levels of above indexes of the TEN group were lower than those of the SPN group(P<0.05). The levels of while blood cell(WBC), C-reactive protein(CRP) and procalcitonin(PCT) of the TEN group were reduced, and the levels of above indexes of the TEN group were lower than those of the SPN group(P<0.05). The colony counts of Bifidobacteria and Lactobacilli of the TEN group were significantly increased, while the colony counts of Enterobacteriaceae and Enterococci were significantly decreased(P<0.05), the colony counts of Bifidobacteria and Lactobacilli of the TEN group were significantly greater than those of the SPN group, while the colony counts of Enterobacteriaceae and Enterococci of the TEN group were significantly less than those of the SPN group(P<0.05). The length of hospital stay of the TEN group was significantly shorter than that of the SPN group(P<0.05). CONCLUSION TEN is more conducive to improvement of nutrition status and intest

关 键 词：儿童 脓毒症 完全肠内营养 辅助肠外营养 肠道屏障功能 肠源性感染 

分 类 号：R725.9[医药卫生—儿科]