Effect of early enteral nutrition on immune regulation and prognosis in patients with severe sepsis
Objective To investigate the clinical effect of early enteral nutrition on patients with severe sepsis.Methods A total of 86 patients with severe sepsis admitted to Nanyang First People's Hospital(Nanyang Key Laboratory of Sepsis Transformation)from September 2022 to January 2024 were included in this study for retrospective analysis.All patients were divided into a study group(43 cases)and a control group(43 cases)according to the timing of enteral nutrition.Both groups received enteral nutrition therapy,and gastric tubes were placed within 24 h after admission.The patients in the study group received enteral nutrition therapy within 24 h after admission,and the patients in the control group received enteral nutrition therapy within 48-72 h after admission.In the study group,there were 24 males and 19 females,aged(64.32±15.21)years,the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score was(19.85±4.10)points,and the sites of infection were at respiratory tract in 32 cases,urinary tract in 6 cases,skin in 3 cases,and other in 2 cases.In the control group,there were 25 males and 18 females,aged(64.17±14.89)years,the APACHE Ⅱ score was(20.06±3.87)points,and the sites of infection were at respiratory tract in 33 cases,urinary tract in 7 cases,skin in 2 cases,and other in 1 case.Intestinal mucosal barrier indexes,inflammatory response related indexes,and immune function related indexes were compared between the two groups on day 1 and day 7 after treatment,and the length of ICU stay and 28-day mortality were compared between the two groups.t test,x2 test,and Fisher exact probability method were used.Results On day 7 after treatment,the levels of intestinal mucosal barrier related indexes in both groups were decreased compared with those on day 1 after treatment,and the levels of these indexes in the study group were lower than those in the control group(all P＜0.05).On day 7 after treatment,the levels of immunoglobulin A(IgA),IgG,CD4+,and CD4+/CD8+in both groups were increased compared with those on day 1 after treatment,and the levels of the above indexes in the study group were higher than those in the control group(all P＜0.05).On day 7 after treatment,the levels of white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)in both groups were decreased compared with those on day 1 after treatment,and the levels of the above indexes in the study group were lower than those in the control group(all P＜0.05).The length of ICU stay in the study group was shorter than that in the control group[(11.32±4.50)days vs.(15.02±3.78)days](P＜0.05).The 28-day mortality rate of the study group was lower than that of the control group[2.33％(1/43)vs.4.71％(2/43)],but the difference was not statistically significant(P＞0.05).Conclusion Compared with delayed enteral nutrition therapy,early enteral nutrition therapy applied in patients with severe sepsis can improve the intestinal microcirculation,contributes to the improvement of immune function,and can reduce the inflammatory response and improve the prognosis.
Severe sepsisEarly enteral nutritionImmune regulationPrognosis
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