首页|不同肠内营养对急性呼吸窘迫综合征患者营养状况和炎症水平及免疫功能的影响

不同肠内营养对急性呼吸窘迫综合征患者营养状况和炎症水平及免疫功能的影响

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目的 观察不同营养策略对重症监护病房(ICU)中急性呼吸窘迫综合征(ARDS)患者营养状况、炎症指标和免疫功能的影响.方法 采用回顾性研究方法.选择 2018 年 3 月至 2021 年 3 月延边大学附属医院重症医学科收治的 51 例ARDS患者作为研究对象.根据不同营养方案将患者分为短肽-整蛋白序贯治疗组(序贯治疗组,25 例)和常规整蛋白治疗组(常规治疗组,26 例).比较治疗 1、5、8 d ARDS患者营养状况指标血红蛋白(Hb)、前白蛋白(PA)、总蛋白(TP)、白蛋白(ALB)和炎症指标白细胞介素-6(IL-6)、降钙素原(PCT)及免疫功能指标CD3+、CD4+、CD8+水平的差异,并观察营养治疗过程中发生喂养不良事件的频率.结果 序贯治疗组治疗8 d PA、TP均明显回升,明显高于常规治疗组[PA(mg/L):144.04±86.75比87.15±54.88,TP(g/L):57.44±6.18 比 52.08±6.58],差异均有统计学意义(均P<0.05);治疗 5d起序贯治疗组ALB明显高于常规治疗组(g/L:28.84±3.13 比 27.07±3.05),持续到治疗 8 d(g/L:30.72±4.59 比 28.30±3.94),差异均有统计学意义(均P<0.05);两组无论组内还是组间淋巴细胞计数、IL-6、PCT、CD3+、CD4+、CD8+比较差异均无统计学意义(均P>0.05);两组均有不同程度胃潴留,并使用胃动力药物,但两组间喂养相关不良事件发生率比较差异均无统计学意义(均P>0.05).结论 ARDS患者早期应用短肽-整蛋白序贯营养在纠正营养状态方面优于单纯应用整蛋白型肠内营养,但对喂养耐受性、炎症指标和免疫指标无明显影响.
Effect of different enteral nutrition on nutrition and inflammation and immunity function in patients with acute respiratory distress syndrome
Objective To observe the effects of different nutritional strategies on the nutritional status,inflammatory markers,and immune function of patients with acute respiratory distress syndrome(ARDS)in the intensive care unit(ICU).Methods A retrospective research method was conducted.A total of 51 ARDS patients admitted to the department of intensive care unit of Yanbian University Affiliated Hospital from March 2018 to March 2021 were selected as the study subjects.According to different nutritional regimens,patients were divided into a short peptide whole protein sequential treatment group(sequential treatment group,25 cases)and a conventional whole protein treatment group(conventional treatment group,26 cases).The differences in nutritional status indicators such as hemoglobin(Hb),prealbumin(PA),total protein(TP),albumin(ALB),inflammatory indicators such as interleukin-6(IL-6),procalcitonin(PCT),and immune function indicators such as CD3+,CD4+,and CD8+ levels were compared among ARDS patients on the 1st,5th,and 8th day of treatment.And the frequency of feeding adverse events was observed during nutritional therapy.Results On the 8th day of treatment,both PA and TP significantly increased in the sequential treatment group,which was significantly higher than that of the conventional treatment group[PA(mg/L):144.04±86.75 vs.87.15±54.88,TP(g/L):57.44±6.18 vs.52.08±6.58],the difference was statistically significant(both P<0.05).From the 5th day of treatment,the ALB in the sequential treatment group was significantly higher than that in the conventional treatment group(g/L:28.84±3.13 vs.27.07±3.05),and continued until the 8th day of treatment(g/L:30.72±4.59 vs.28.30±3.94),with statistically significant differences(both P<0.05).There was no statistically significant difference in lymphocyte count,IL-6,PCT,CD3+,CD4+,and CD8+ between the two groups,both within and between groups(all P>0.05).Both groups had gastric retention to varying degrees and used gastric motility drugs,but there was no statistical difference in the incidence of feeding related adverse events between the two groups(all P>0.05).Conclusion Early use of short peptide whole protein sequential nutrition in ARDS patients is better than simple use of whole protein enteral nutrition in correcting nutritional status,but it has no significant effect on feeding tolerance,inflammation indicators,and immune indicators.

Acute respiratory distress syndromeShort-peptideSequential nutritionImmunity function

朴鲜女、许惠仙

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延边大学附属医院临床营养科,吉林延吉 133000

急性呼吸窘迫综合征 短肽 序贯营养 免疫功能

吉林省教育厅科学技术研究项目延边大学应用基础项目

JJKH20220550KJ2021-33

2024

中国中西医结合急救杂志
中国中西医结合学会

中国中西医结合急救杂志

CSTPCD
影响因子:1.925
ISSN:1008-9691
年,卷(期):2024.31(1)
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