肠内营养支持治疗重度肺部感染合并脓毒症儿童的效果  

Effect of enteral nutritional support in the treatment of children with severe pulmonary infection and sepsis

作　　者：陈晨 王琪 苏军 崔利丹 金志鹏 CHEN Chen;WANG Qi;SU Jun;CUI Lidan;JIN Zhipeng(Children's Hospital Affiliated to Zhengzhou University/Zhengzhou Children's Hospital/Henan Children's Hospital PICU,Zhengzhou,Henan,China,450000)

机构地区：[1]河南省儿童医院/郑州儿童医院/郑州大学附属儿童医院儿科重症监护,河南郑州450000

出　　处：《分子诊断与治疗杂志》2023年第2期193-196,共4页Journal of Molecular Diagnostics and Therapy

基　　金：河南省医学科技攻关计划项目(2018020697)。

摘　　要：目的 探讨肠内营养支持在重度肺部感染合并脓毒症儿童中的应用及对血清总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)及肠黏膜屏障的影响。方法 选择2015年1月至2020年1月在河南省儿童医院接受治疗的120例重度肺部感染合并脓毒症儿童,采用随机数表法分为试验组(n=61)和对照组(n=59)。对照组给延迟肠内营养治疗,试验组给予早期肠内营养支持治疗。比较两组TP、ALB、PA、肠脂肪酸结合蛋白(IFABP)、二胺氧化酶(DAO)、炎症因子、肠道菌群水平变化情况及不耐受发生情况。结果 治疗后,试验组和对照组血清TP、ALB、PA水平均随着时间的推移而升高,且试验组高于对照组,比较差异有统计学意义(t=6.503,6.909,5.494,P<0.05);治疗后,试验组和对照组IFABP、DAO水平均随着时间的推移而降低,且试验组低于对照组,差异有统计学意义(t=23.124,5.181,P<0.05);治疗后,试验组和对照组PCT、CRP、IL-6及TNF-α水平均随着时间的推移而降低,且试验组低于对照组,差异有统计学意义(t=9.116,7.429,18.449,9.209,P<0.05);治疗后,试验组和对照组双歧杆菌、嗜酸乳杆菌水平均随着时间的推移而升高,且试验组高于对照组,差异有统计学意义(t=5.612,7.809,P<0.05);两组不耐受主要为腹胀、腹泻、呕吐及胃潴留,两组总不耐受率比较,差异有统计学意义(χ^(2)=9.347,P<0.05)。结论 在重度肺部感染合并脓毒症儿童中早期肠内营养支持有一定的治疗效果,可能与其可改善血清TP、ALB、PA及肠黏膜屏障有关。Objective To explore the application of enteral nutrition support in children with severe pulmonary infection and sepsis and its effect on serum total protein(TP),albumin(ALB),prealbumin(PA)and intestinal mucosal barrier. Methods 120 children with severe pulmonary infection complicated with sepsis who were treated in Henan Children ’s Hospital from January 2015 to January 2020 were selected and divided into the experimental group(n=61)and the control group(n=59)by random number table method. The control group received delayed enteral nutrition treatment,the experimental group received early enteral nutrition support treatment. The changes of TP,ALB,PA,intestinal fatty acid binding protein(IFABP),diamine oxidase(DAO),inflammatory factors,intestinal microflora and the occurrence of intolerance were compared between the two groups. Results After treatment,serum TP,ALB and PA levels in the experimental group and the control group increased with time,and the experimental group was higher than in the control group,the difference was statistically significant(t=6.503,6.909,5.494,P<0.05). After treatment,IFABP and DAO levels in the experimental group and the control group decreased over time,and the experimental group was lower than the control group,the difference was statistically significant(t=23.124,5.181,P<0.05). After treatment,the levels of PCT,CRP,IL-6 and TNF-α in the experimental group and control group decreased with time,and the levels in the experimental group were lower than those in the control group,the difference was statistically significant(t=9.116,7.429,18.449,9.209,P<0.05). After treatment,the levels of bifidobacterium and Lactobacillus acidophilus in the experimental group and the control group increased over time,and the levels in the experimental group were higher than those in the control group,with statistical significance(t=5.612,7.809,P<0.05). The intolerance of the two groups was mainly abdominal distension,diarrhea,vomiting and gastric retention. The total intolerance rate between the two

关 键 词：肠内营养支持 重度肺部感染 脓毒症 总蛋白 清蛋白 前清蛋白 肠黏膜屏障 

分 类 号：R720.597[医药卫生—急诊医学] R725.6[医药卫生—儿科] R459.3[医药卫生—临床医学]