[1]戴晓勇,陈永珍,叶宥文,等.不同营养支持方式对血流动力学不稳定脓毒性休克患者T淋巴细胞亚群及疾病预后的影响*[J].陕西医学杂志,2020,49(2):183-186.
　DAI Xiaoyong,CHEN Yongzhen,YE Weiwen,et al.Effects of different nutritional supports on T lymphocyte subsets and prognosis of septic shock patients with unstable hemodynamics[J].,2020,49(2):183-186.
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不同营养支持方式对血流动力学不稳定脓毒性休克患者T淋巴细胞亚群及疾病预后的影响*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
49
期数:
2020年2期
页码:
183-186
栏目:
临床研究
出版日期:
2020-02-05

文章信息/Info

Title:
Effects of different nutritional supports on T lymphocyte subsets and prognosis of septic shock patients with unstable hemodynamics
文章编号:
DOI:〖HT5K〗10.3969/j.issn.10007377.2020.02.015
作者:
戴晓勇; 陈永珍; 叶宥文; 杨晓英; 霍玉洁; 庞秀峰
同济大学附属杨浦医院(上海市杨浦区中心医院)急诊科(上海200090)
Author(s):
DAI Xiaoyong; CHEN Yongzhen; YE Weiwen; et al.
Department of Emergency, Yangpu Hospital,Tongji University(Yangpu District Central Hospital,Shanghai)(Shanghai 200090)
关键词:
肠内营养;  肠外营养;  脓毒性休克;  血流动力学;  免疫功能;  预后
Keywords:
Enteral nutrition;  Parenteral nutrition;  Septic shock;  Hemodynamics;  Immune function;  Prognosis
分类号:
R639
文献标志码:
A
摘要:
目的:探讨不同营养支持方式对血流动力学不稳定的脓毒性休克患者T淋巴细胞亚群及预后的影响。方法:96例脓毒性休克患者,根据营养支持方式的不同,分为肠内营养组(EN组,n=51)和肠外营养组(PN组,n=45),分别于入住ICU后尽早给予能全力、卡文,目标热量为20～25 kCal/(kg·d)。比较两组患者的治疗前后营养、T淋巴细胞亚群指标及预后情况。结果:治疗后1、7 d,两组血清白蛋白(ALB)、血红蛋白(HB)、前白蛋白(PA)水平均较治疗前显著升高(P<0.05); 两组治疗前、治疗后1、7 d 各营养指标水平比较,差异均无统计学意义(P>0.05)。治疗后7 d,两组免疫功能指标均较治疗前显著改善(P<0.05); 两组不同时刻T淋巴细胞比较,差异均无统计学意义(P>0.05)。两组ICU住院时间、连续性肾脏替代治疗(CRRT)时间、机械通气时间、APACHE II评分、院内感染率、28 d病死率比较,差异均无统计学意义(P>0.05)。PN组呕吐和腹泻、急性结肠假性梗阻、肠缺血发生率及使用胃肠动力药物比例均较EN组明显降低(P<0.05)。结论:血流动力学不稳定的脓毒症休克患者早期给予PN支持策略的效果优于EN,不仅能改善营养状况,增强免疫功能,还能降低胃肠道并发症。
Abstract:
Objective:To explore the influence of different nutritional supports on T lymphocyte subsets and prognosis of septic shock patients with unstable hemodynamics.Methods:A retrospective analysis was conducted on 96 patients with septic shock admitted to ICU.According to different nutritional support methods,they were divided into enteral nutrition group(EN group,n=51)and parenteral nutrition group(PN group,n=45),who were given nutrison fibre and carvin as early as possible after admission to ICU,respectively,with a target calorie of 20-25 kCal/(kg·d).The nutrition indicators,T lymphocyte subgroup and prognosis of the two groups were compared before and after treatment.Results:The levels of ALB,PA and HB in both groups were significantly higher at first and seventh day after treatment than those before treatment(P<0.05).There was no statistically significant difference between the two groups in the levels of nutrition indicators before treatment,at first and seventh after treatment(P>0.05).At seventh day after treatment,the immune function indexes in both groups were significantly improved compared with before treatment(P<0.05).There was no significant difference in T lymphocytes between the two groups at different times(P>0.05).There was no significant difference in ICU hospitalization time,CRRT time,mechanical ventilation time,APACHE II score,nosocomial infection rate,and 28-day mortality between the two groups(P>0.05).The incidence of vomiting and diarrhea,acute colonic pseudoobstruction,intestinal ischemia and the use of gastrointestinal motility drugs in the PN group were significantly lower than those in the EN group(P<0.05).Conclusions:Efficacy of early PN support strategy are better than EN for Hemodynamically unstable patients with septic shock,which can not only improve nutritional status,enhance immune function,but also reduce gastrointestinal complications.

参考文献/References:

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备注/Memo

备注/Memo:
*上海市卫生和计划生育委员会课题(201840341)
更新日期/Last Update: 2020-03-25