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

发布时间：2018-01-11 18:03

本文关键词：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　出处：《肠外与肠内营养》2017年02期 　论文类型：期刊论文

【摘要】：目的:研究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。方法:将90例重症肺炎病人随机分为研究组和对照组,每组各45例。除常规治疗外,研究组病人给予免疫增强型肠内营养(EN)制剂(瑞能,TPF-T)进行免疫EN支持治疗。对照组病人给予普通型EN制剂(瑞素,TP)进行标准EN支持治疗。比较两组病人治疗前和治疗第5和第10天的一般情况、肠黏膜屏障功能指标及免疫功能指标的变化。观察并比较治疗第10天两组的有创通气时间、APACHEⅡ评分和临床疗效。结果:治疗第5和10天后,两组病人的体温、呼吸、心率、白细胞计数均较治疗前明显降低(P0.05),且研究组显著低于对照组(P0.05)。治疗第5和10天后,两组病人的血浆内毒素(ET)、二胺氧化酶(DAO)水平均较治疗前显著降低(P0.05),且研究组水平显著低于对照组(P0.05)。治疗第5和10天后,两组病人的IgA、IgG、IgM、CD3~+、CD4~+细胞数和CD4~+/CD8~+水平均较治疗前显著升高(P0.05),且研究组水平显著高于对照组(P0.05)。治疗第10天后,研究组病人有创通气时间和APACHEⅡ评分显著低于对照组(P0.05),临床总有效率明显高于对照组(P0.05)。结论:免疫EN治疗可更有效地保护重症肺炎病人的肠黏膜屏障功能、改善免疫状态,增强病人的免疫功能,减少有创通气时间,提高临床疗效。
[Abstract]:Objective: To study the effect of enteral nutrition on intestinal mucosal barrier and immune function in patients with severe pneumonia. Methods: 90 cases of severe pneumonia patients were randomly divided into study group and control group, 45 cases in each group. Besides routine treatment, patients in study group were treated with immune enhancing enteral nutrition (EN) formulations (Supportan. TPF-T) were immunized with EN support treatment. Control group patients were given conventional EN formulations (Fresubin, TP) standard EN support treatment. General treatment of the two groups were compared before and after fifth and tenth days, the changes of intestinal mucosa barrier function and immune function index. To observe and compare the two groups for tenth days the duration of ventilation, APACHE score and clinical curative effect. Results: fifth and 10 days after treatment, two groups of the patient's body temperature, respiration, heart rate, white blood cell count was significantly lower than before treatment (P0.05), and the study group was significantly lower than the control group (P0.05) for fifth. And 10 days later, plasma endotoxin in two groups (ET), two amine oxidase (DAO) levels were significantly lower than those before treatment (P0.05), and the study group was significantly lower than the control group (P0.05). The fifth and 10 days after treatment, two groups of IgA, IgG, IgM, CD3~+, CD4~+ cell number and the level of CD4~+/CD8~+ was significantly higher than that before treatment (P0.05), and the study group was significantly higher than the control group (P0.05). After tenth days of treatment, patients in the study group of invasive ventilation time and APACHE score was significantly lower than the control group (P0.05), the clinical total effective rate was significantly higher than that of control group (P0.05). Conclusion: intestinal mucosal barrier function of immune EN treatment can effectively protect patients with severe pneumonia, improve immunity, enhance the immune function of patients, reduce the time of invasive ventilation, improve clinical curative effect.

【作者单位】：济宁市第一人民医院重症医学科;济宁市第一人民医院乳甲外科;济宁市精神病防治院心电图室;
【基金】：山东省济宁市科技发展计划项目(2015-57-04)
【分类号】：R459.3;R563.1
【正文快照】： 重症肺炎是呼吸科的常见急危重症,起病急,可快速发展为感染性休克和多器官功能障碍综合征(MODS),病死率较高,需积极干预治疗[1]。因此,急需进一步了解重症肺炎的患病机制,寻找有效的方法改善预后。近来研究发现,含特殊营养物质的免疫增强型肠内营养(EN)支持可保护肠黏膜屏障,

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