摘要
目的 观察使用免疫增强型肠内营养(EN)乳剂对机械通气(MV)危重患者免疫功能的干预作用.方法 选择2015年7月至2017年6月台州市第一人民医院急诊重症加强治疗病房(EICU)收治的MV行EN支持患者120例,按计算机产生的随机数字分为免疫增强营养组及标准营养组,最终76例患者纳入本研究,其中免疫增强营养组36例,标准营养组40例.比较EN后1、3、7 d两组急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)和EN后1、7 d两组免疫指标分泌型免疫球蛋白(IgA、IgG、IgM)和淋巴细胞亚群(CD4、CD8)以及MV时间、ICU住院时间的差异.结果 免疫增强营养组与标准营养组各时间点APACHEⅡ评分比较差异无统计学意义;EN 7 d免疫增强营养组SOFA评分较标准营养组显著降低(分:2.56±1.38比3.68±2.96),免疫球蛋白IgA、IgG、IgM水平较标准营养组显著升高〔IgA(mg/L):2967.6±635.6比2525.0±592.7,IgG(mg/L):14982.5±2899.7比12996.4±2875.9,IgM(mg/L):1206.8±233.3比1093.2±165.1,均P<0.05〕,CD4、CD8较标准组显著升高(CD4:0.45±0.06比0.37±0.10, CD8:0.20±0.03比0.18±0.04,均P<0.05),MV时间(h:122.33±63.91比155.69±77.06)和ICU住院时间(h:197.57±70.60比239.61±84.83)均较标准营养组明显缩短(均P<0.05).结论 与标准型EN比较,免疫增强型EN乳剂可提高危重症MV患者的免疫功能,并能缩短患者MV时间及ICU住院时间.
Objective To observe the intervention effect of immune-enhancing enteral nutrition (EN) emulsion on immune function of critically ill patients with mechanical ventilation (MV). Methods One hundred and twenty critically ill patients with MV admitted to the Department of Emergency Intensive Care Unit (EICU) of Taizhou First People's Hospital from July 2015 to June 2017 were enrolled, and they were divided into immune-enhancing EN group and standard EN group by random numbers generated by a computer. Ultimately, 76 cases were enrolled in the study, among them, 36 cases were in the immune-enhancing nutrition group and 40 cases were in the standard nutrition group. The differences of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), the sequential organ function evaluation (SOFA) score on 1, 3, 7 days and immunity indexes (secretory immuno-globulins IgA, IgG, IgM), lymphocyte subpopulation (CD4 and CD8), duration of MV and the length of ICU stay on the 1, 7 days after EN were compared. Results Comparisons between the immune-enhancing EN group and standard EN group showed: APACHE Ⅱ score had no statistically significant difference between the two groups at each time point, SOFA score on 7 days after EN treatment was significantly decreased in the immune-enhancing EN group (2.56±1.38 vs. 3.68±2.96, P < 0.05); IgA, IgG, IgM were obviously higher in the immune-enhancing EN group than those in standard EN group on 7 days after treatment [IgA (mg/L): 2 967.6±635.6 vs. 2 525.0±592.7, IgG (mg/L): 14 982.5±2 899.7 vs. 12 996.4±2 875.9, IgM (mg/L): 1 206.8±233.3 vs. 1 093.2±165.1, all P < 0.05], CD4 (0.45±0.06 vs 0.37± 0.10) and CD8 (0.20±0.03 vs. 0.18±0.04) were significantly higher than those in standard EN group (both P < 0.05). The MV time (hours): 122.33±63.91 vs. 155.69±77.06) and ICU stay time (hours): 197.57±70.60 vs. 239.61±84.83) of the immuno-enhancing EN group were markedly shorter than those of the standard EN group (both P < 0.05). Conclusion Compared with standard EN, the immune-enhancing EN emulsion can improve the immune function of critically ill patients with MV, and shorten the duration of MV support and the length of ICU stay.
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2018年第2期169-172,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省台州市重点支撑学科(台卫发〔2016〕136)%浙江省台州市黄岩区科技计划项目(2016044-16) Subject of Emphasis of Zhejiang Taizhou([2016]136)%Science and Technology Bureau Project of Huangyan District, Taizhou City, Zhejiang Province(2016044-16)
关键词
免疫增强
肠内营养
危重症
机械通气
Immune enhancement
Enteral nutrition
Critical illness
Mechanical ventilation
