肠内增强免疫营养对重症肺炎患者免疫功能及预后的影响
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摘要
目的探讨肠内增强免疫营养对重症肺炎患者免疫功能及预后的影响并分析疗效。方法选择2016年3月至2017年12月我院收治的100例重症肺炎患者,依据抽签法分为两组,其中研究组50例,常规组50例。研究组患者在常规治疗基础上给予免疫增强型肠内营养制剂,对照组患者在常规治疗基础上给予普通肠内营养制剂。比较两组患者干预后粪便菌群变化,干预前后免疫功能和凝血功能的变化,并记录两组患者干预后的并发症发生率和死亡人数。结果研究组患者菌群失调发生率为4.00%(2/50),低于常规组的20.00%(10/50)(P<0.05)。干预前,两组患者免疫功能和凝血功能水平差异无统计学意义(P>0.05)。干预治疗1周和2周后,两组患者CD_3~+细胞、CD_4~+细胞、CD_4~+/CD_8~+、IgA、IgM和IgG水平均上升,CD_8~+细胞、FIB和D-二聚体水平均降低,且研究组CD_3~+细胞、CD_4~+细胞、CD_4~+/CD_8~+、IgA、IgM和IgG水平均高于常规组,CD_8~+、FIB和D-二聚体水平均低于常规组(P<0.05)。研究组患者并发症总发生率为10.00%(5/50),低于常规组(P<0.05)。对照组有1例死亡,研究组未出现死亡。结论肠内免疫增强营养支持可提高患者疗效,改善患者免疫功能和凝血功能,减少并发症发生,提高患者预后。
Objective To explore and analyze the effect of enhanced enteral immunonutrition on the immune function and prognosis of patients with severe pneumonia.Methods 100 patients with severe pneumonia treated in our hospital from March 2016 to December 2017 were selected and divided into the observation group or control group based on the lottery method,with 50 patients in each group.The patients in the observation group were treated with enhanced enteral immunonutrition preparations while those in the control group were treated with normal enteral nutrition preparations.The changes of fecal flora after intervention,immune and coagulation functions before and after intervention,and the incidence of complications and deaths after intervention in both groups were recorded.Results The incidence of dysbacteriosis in the observation group was 4.00%(2/50),lower than the 20.00%(10/50)in the control group(P<0.05).Before the intervention,there was no significant differences in immune and coagulation functions between the two groups(P>0.05).After 1 and 2 weeks of intervention,the levels of CD_3~+ cells,CD_4~+ cells,CD_4~+/CD_8~+,IgA,IgM and IgG increased while those of CD_8~+ cells,FIB and D-dimer decreased in both groups;The levels of CD_3~+ cells,CD_4~+ cells,CD_4~+/CD_8~+,IgA,IgM and IgG were higher,while those of CD_8~+,FIB and D-dimer were lower in the observation group than those in the control group,respectively(Ps<0.05).The overall incidence of complications in the observation group was 10.00%(5/50),lower than that in the control group(P<0.05).One death occurred in the control group vs none in the observation group.Conclusion Intestinal enhanced immunonutritional support can improve the efficacy,increase immune and coagulation functions,reduce complications,and improve the prognosis of patients.
Objective To explore and analyze the effect of enhanced enteral immunonutrition on the immune function and prognosis of patients with severe pneumonia.Methods 100 patients with severe pneumonia treated in our hospital from March 2016 to December 2017 were selected and divided into the observation group or control group based on the lottery method,with 50 patients in each group.The patients in the observation group were treated with enhanced enteral immunonutrition preparations while those in the control group were treated with normal enteral nutrition preparations.The changes of fecal flora after intervention,immune and coagulation functions before and after intervention,and the incidence of complications and deaths after intervention in both groups were recorded.Results The incidence of dysbacteriosis in the observation group was 4.00%(2/50),lower than the 20.00%(10/50)in the control group(P<0.05).Before the intervention,there was no significant differences in immune and coagulation functions between the two groups(P>0.05).After 1 and 2 weeks of intervention,the levels of CD_3~+ cells,CD_4~+ cells,CD_4~+/CD_8~+,IgA,IgM and IgG increased while those of CD_8~+ cells,FIB and D-dimer decreased in both groups;The levels of CD_3~+ cells,CD_4~+ cells,CD_4~+/CD_8~+,IgA,IgM and IgG were higher,while those of CD_8~+,FIB and D-dimer were lower in the observation group than those in the control group,respectively(Ps<0.05).The overall incidence of complications in the observation group was 10.00%(5/50),lower than that in the control group(P<0.05).One death occurred in the control group vs none in the observation group.Conclusion Intestinal enhanced immunonutritional support can improve the efficacy,increase immune and coagulation functions,reduce complications,and improve the prognosis of patients.
引文
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[6]WANG Jieqiong,WU Xueliang,GUO Fei,et al.The Application on Nutritional Risk Screening 2002in perioperative period of colorectal cancer[J].Chin Med Guid,2018,15(2):100-103.(in Chinese)王洁琼,武雪亮,郭飞,等.NRS 2002营养风险筛查在结直肠癌围术期中的应用[J].中国医药导报,2018,15(2):100-103.
[7]YANG Zhixun,FAN Tiebin,LI Jie.Xiyanping Injection for severe pneumonia with syndrome of phlegm-heat obstructing lung[J].Beijing J Tradit Chin Med,2014,33(12):894-896.(in Chinese)杨志旭,范铁兵,李洁.喜炎平注射液治疗重症肺炎痰热壅肺证的临床观察[J].北京中医药,2014,33(12):894-896.
[8]AR Blaser,J Starkopf,W Alhazzan,et al.Early enteral nutrition in critically ill patients:ESICM clinical practice guidelines[J].Intens Care Med,2017,43(3):380-398
[9]CHI Yongsheng,WANG Baifei,FU Aixia,et al.The influence of enteral nutrition liquid rich in omega-3polyunsaturated fatty acids on clinical therapeutic effect in patients with acute respiratory distress syndrome undergoing mechanical ventilation[J].Chin J Integr Tradit&West Med Intens and Crit Care,2017,24(3):316-319.(in Chinese)迟永生,汪百飞,符爱霞,等.ω-3多不饱和脂肪酸营养液对ARDS机械通气患者临床疗效的影响[J].中国中西医结合急救杂志,2017,24(3):316-319.
[10]ZHOU Ganping,LIN Chunyan,HUANG Huatian.Analysis of dynamic changes of procalcitonin and value of anti-infection therapy in elderly patients with severe pneumonia[J].Anti Infect Pharm,2015,12(2):200-203.(in Chinese)周甘平,林春燕,黄华田.老年重症肺炎患者降钙素原的动态变化及其抗感染治疗的价值分析[J].抗感染药学,2015,12(2):200-203.
[11]SONG Ge,LYU Yuetao,DI Linlin,et al.Effect of immune enteral nutrition on intestinal mucosal barrier and immune function in patients with severe pneumonia[J].Chin J Crit Care Med,2017,24(2):86-89+93.(in Chinese)宋歌,吕月涛,狄林林,等.免疫肠内营养对重症肺炎病人肠黏膜屏障及免疫功能的影响[J].肠外与肠内营养,2017,24(2):86-89+93.
[12]TIAN Jia.Efficacy of early nutrition support combined with glutamine and low molecular heparin in elderly patients with severe pneumonia[J].Chongqing Med,2016,45(19):2648-2651.(in Chinese)田佳.早期营养支持联合谷氨酰胺和低分子肝素对老年重症肺炎患者的疗效研究[J].重庆医学,2016,45(19):2648-2651.
[13]HU Ling,ZHANG Li.Comparative study of enteral ecoimmunonutrition and immune enhanced enteral nutrition in treatment of severe pneumonia[J].J Clin Pulmon Med,2018,23(3):525-529.(in Chinese)胡玲,章莉.肠内免疫微生态营养与肠内增强免疫营养在治疗重症肺炎的对比研究[J].临床肺科杂志,2018,23(3):525-529.
[2]ZHU Yunxiang,SHEN Yaowen,WU Tao,et al.The influence study of levofloxacin combined with ambroxol hydrochloride in the treatment of elderly patients with severe pneumonia[J].J Hunan Normal Univ(Med Sci),2017,14(5):148-151.(in Chinese)朱云祥,沈垚文,武韬,等.左氧氟沙星与盐酸氨溴索联合治疗对重症肺炎老年患者免疫功能、肺功能和血气指标的影响研究[J].湖南师范大学学报(医学版),2017,14(5):148-151.
[3]CHEN Guokun.Protective effect of Bifid Triple Viable Capsules on intestinal mucosal barrier function of patients with severe pneumonia[J].Chin J Microecol,2014,26(11):1302-1304.(in Chinese)陈坤伦.双歧杆菌三联活菌肠溶胶囊对重症肺炎患者肠黏膜屏障功能的保护作用[J].中国微生态学杂志,2014,26(11):1302-1304.
[4]CAO Lang,YE Xianghong,PENG Nanhai,et al.Treatment and care of early nourishment nutrition in 1case of myocarditis with severe pneumonia[J].Parent&Enter Nutrit,2016,23(3):191-192.(in Chinese)曹岚,叶向红,彭南海,等.1例心肌炎合并重症肺炎病人早期滋养性营养的治疗护理[J].肠外与肠内营养,2016,23(3):191-192.
[5]Chinese Medical Association Association of Emergency Physicians.China expert consultation on acute pneumonia clinical practice[J].Chin J Crit Care Med,2016,36(2):97-107.(in Chinese)中国医师协会急诊医师分会.中国急诊重症肺炎临床实践专家共识[J].中国急救医学,2016,36(2):97-107.
[6]WANG Jieqiong,WU Xueliang,GUO Fei,et al.The Application on Nutritional Risk Screening 2002in perioperative period of colorectal cancer[J].Chin Med Guid,2018,15(2):100-103.(in Chinese)王洁琼,武雪亮,郭飞,等.NRS 2002营养风险筛查在结直肠癌围术期中的应用[J].中国医药导报,2018,15(2):100-103.
[7]YANG Zhixun,FAN Tiebin,LI Jie.Xiyanping Injection for severe pneumonia with syndrome of phlegm-heat obstructing lung[J].Beijing J Tradit Chin Med,2014,33(12):894-896.(in Chinese)杨志旭,范铁兵,李洁.喜炎平注射液治疗重症肺炎痰热壅肺证的临床观察[J].北京中医药,2014,33(12):894-896.
[8]AR Blaser,J Starkopf,W Alhazzan,et al.Early enteral nutrition in critically ill patients:ESICM clinical practice guidelines[J].Intens Care Med,2017,43(3):380-398
[9]CHI Yongsheng,WANG Baifei,FU Aixia,et al.The influence of enteral nutrition liquid rich in omega-3polyunsaturated fatty acids on clinical therapeutic effect in patients with acute respiratory distress syndrome undergoing mechanical ventilation[J].Chin J Integr Tradit&West Med Intens and Crit Care,2017,24(3):316-319.(in Chinese)迟永生,汪百飞,符爱霞,等.ω-3多不饱和脂肪酸营养液对ARDS机械通气患者临床疗效的影响[J].中国中西医结合急救杂志,2017,24(3):316-319.
[10]ZHOU Ganping,LIN Chunyan,HUANG Huatian.Analysis of dynamic changes of procalcitonin and value of anti-infection therapy in elderly patients with severe pneumonia[J].Anti Infect Pharm,2015,12(2):200-203.(in Chinese)周甘平,林春燕,黄华田.老年重症肺炎患者降钙素原的动态变化及其抗感染治疗的价值分析[J].抗感染药学,2015,12(2):200-203.
[11]SONG Ge,LYU Yuetao,DI Linlin,et al.Effect of immune enteral nutrition on intestinal mucosal barrier and immune function in patients with severe pneumonia[J].Chin J Crit Care Med,2017,24(2):86-89+93.(in Chinese)宋歌,吕月涛,狄林林,等.免疫肠内营养对重症肺炎病人肠黏膜屏障及免疫功能的影响[J].肠外与肠内营养,2017,24(2):86-89+93.
[12]TIAN Jia.Efficacy of early nutrition support combined with glutamine and low molecular heparin in elderly patients with severe pneumonia[J].Chongqing Med,2016,45(19):2648-2651.(in Chinese)田佳.早期营养支持联合谷氨酰胺和低分子肝素对老年重症肺炎患者的疗效研究[J].重庆医学,2016,45(19):2648-2651.
[13]HU Ling,ZHANG Li.Comparative study of enteral ecoimmunonutrition and immune enhanced enteral nutrition in treatment of severe pneumonia[J].J Clin Pulmon Med,2018,23(3):525-529.(in Chinese)胡玲,章莉.肠内免疫微生态营养与肠内增强免疫营养在治疗重症肺炎的对比研究[J].临床肺科杂志,2018,23(3):525-529.