| 早期肠内营养对机械通气患者营养状态和肠黏膜屏障的影响 |
| 投稿时间：2017-12-18 修订日期：2018-01-15 点此下载全文 |
| 引用本文：赵辉,潘景业,郑贞苍.早期肠内营养对机械通气患者营养状态和肠黏膜屏障的影响[J].医学研究杂志,2018,47(8):116-120 |
| DOI：
10.11969/j.issn.1673-548X.2018.08.027 |
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| 基金项目:台州市科技计划项目（1701KY58） |
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| 中文摘要:目的 研究早期肠内营养（enteral nutrition，EN）对机械通气（mechanical ventilation，MV）患者营养状态和肠道屏障功能的影响。方法 笔者医院共收治MV患者112例，随机将其分为EN组56例和全肠外营养（total parenteral nutrition，TPN）组56例，比较两组患者治疗前一般临床资料及治疗后血清营养指标、炎性因子水平，肠道屏障功能指标及预后等方面的差异。结果 两组MV患者在入院临床资料中比较，差异均无统计学意义（P均>0.05）。在营养指标方面，EN组患者自第7天起血清白蛋白，前白蛋白均显著性高于TPN组；至第14天EN组患者血清转铁蛋白显著性高于TPN组。在炎性因子方面，第7天起EN组血清CRP及TNF-α水平均显著性低于TPN组。在肠道黏膜屏障功能指标方面，第7天起EN组血清内毒素，二胺氧化酶及D-乳酸水平亦均显著性低于TPN组。在临床预后方面，EN组患者机械通气时间及ICU时间均明显低于TPN组，两组呼吸机相关性肺炎、住院时间及病死率差异无统计学意义。结论 早期EN可以有效地改善MV患者营养状态，降低机体炎性因子水平，保护肠道黏膜屏障功能，从而改善患者预后。 |
| 中文关键词:机械通气 肠内营养 全肠外营养 营养状态 肠黏膜屏障 |
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| Effect of Early Enteral Nutrition on Nutritional Status and Intestinal Mucosal Barrier in Mechanical Ventilated Patients |
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| Abstract:Objective To investigate the protective effect of early enteral nutrition (EN) on nutritional status and intestinal mucosal barrier in mechanical ventilation (MV) patients. Methods A total of 112 AP patients admitted to our hospital were randomly divided into an EN group (56 cases) and a total parenteral nutrition (TPN) group (56 cases), clinical characteristics and the level of serum nutritive indexes, inflammation cytokines, intestinal barrier function indexes and clinical outcomes were compared between these two groups. Results No significant differences were found in the demographic characteristics between EN and TPN group (P all >0.05). In the aspect of nutritive indexes, EN group show significantly higher level of serum albumin and prealbumin since the 7th day (t=4.623; 4.517, P all <0.05); and in the 14th day, EN group also showed significantly higher level of serum transferrin. In the aspect of inflammation cytokines, EN group showed significantly lower level of both serum CRP and TNF-α(t=2.211; 3.010, P all <0.05) since the 7th. In the aspect of intestinal barrier function, patients in EN group showed significantly lower level of serum endotoxin, accompanied with significantly lower serum level of DAO and D-lactic since the 7th day. In the aspect of clinical outcomes, EN group showed obviously shorter length of MV time and ICU stays. However, statistical differences were not found in VAP, hospital stays or in mortality between these two groups. Conclusion Early EN can effectively improve MV patients' nutritional status, decrease the level of serum inflammation cytokines, protect the function of intestinal mucosa barrier and ameliorate their clinical outcomes. |
| keywords:Mechanical ventilation Enteral nutrition Total parenteral nutrition Nutritional status Intestinal mucosal barrier |
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