摘要
目的观察ω-3不饱和脂肪酸肠内营养(EN)对老年心力衰竭(HF)患者临床疗效的影响。方法选择2013年4月至2018年4月杭州市老年病医院重症医学科(ICU)收治的126例老年HF患者作为研究对象,将患者按营养制剂不同分为瑞先组和瑞能组,每组63例。瑞能组给予瑞能营养液(ω-3不饱和脂肪酸含量3 g/L)治疗;瑞先组给予瑞先营养液治疗。按体质量计算所需热量标准,两组均为104.6 ~125.5 kJ·kg^-1·d^-1.观察两组患者治疗前后白蛋白(αlb),前白蛋白(Pα)、转铁蛋白(TRF)、白细胞介素-6(IL-6)、超敏 C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)等指标,以及 CD3+、CD4+、CD8+、CD4+/CD8+等T淋巴细胞亚群,血浆N末端脑钠肽前体(NT-proBNP),左室射血分数(LVEF)的变化,并观察两组预后指标和不良反应发生率。结果两组患者治疗后血清αlb, Pα和TRF水平及免疫功能指标CD3\CD4\CD8+、CD4+/CD8*均较治疗前显著升高(均P<0.05),血清IL-6、hs-CRP、TNF-α和NT-proBNP水平均较治疗前显著降低(均PV0.05),且治疗后瑞能组上述指标的变化较瑞先组更显著〔αlh(g/L): 36.91 ±4.49比36.31 ±3.95, Pα(mg/L): 190.26± 15.39 比 188.51 ± 17.62, TRF(g/L): 2.31 ±0.44 比 2.25±0.71, IL-6(ng/L):312.53±42.69 比 372.45±51.25, hs-CRP(mg/L): 20.43± 15.72 比 35.81 ±14.28, TNF-α(ng/L): 81.36± 17.32比 152.67 ± 21.71, CD3+: 0.59 ± 0.06 比 0.55 ± 0.05, CD4+: 0.33 ± 0.05 比 0.28 ±0.04, CD8+: 0.23 ±0.03 比0.21 ±0.04,CD4+/CD8*:1.55±0.34 比 1.36±0.41,NT-proBNP( ng/L): 149.00 ±0.38 比 242.00±0.56,均 P<0.05 ];瑞能组患者ICU住院时间、总住院时间均较瑞先组明显缩短〔ICU住院时间(d): 9.41 ±3.19比12.39±3.75,总住院时间(d): 15.24±4.63比18.26±5.18,均P<0.05〕,不良反应发生率均较瑞先组降低[4.76%(3/63)比17.46%(11/63), PV0.05〕;瑞能组和瑞先组心功能指标LVEF比较差异均无统计学意义(0.418±0.053比0.417± 0.052, P>0.05)。结论早期应用ω-3不饱和脂肪酸EN可�
Objective To investigate the clinical efficacy of ω-3 unsaturated fatty acid enteral nutrition (EN) for treatment of elderly patients with heart failure (HF). Methods One hundred and twenty six elderly patients with HF admitted to Hangzhou Geriatric Hospital from April 2013 to April 2018 were enrolled to be the study objects, and they were divided into a TPF group and a TPF-T group (63 cases in each group) according to the difference in nutrition preparation. The nasal feeding with EN solution rich in ω-3 unsaturated fatty acid was applied in the TPF-T group;while in the TPF group, nasal feeding with common EN solution was given. According to the body mass quantity to calculate the necessary heat standard, the target energy established for the two groups was 104.6-125.5 kJ ? kg-1 ? d"1. The changes of levels of albumin (Alb), prealbumin (PA), transferrin (TRF), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α(TNF-α), T lymphocyte subsets such as CD3+, CD4*, CD8+, CD4+/CD8+, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), and left ventricular ejection fraction (LVEF) were observed in the two groups before and after treatment, and the prognostic indexes and incidence of adverse reactions of the two groups were also observed. Results After treatment, the levels of Alb, PA, TRF, and the immune function indexes CD3+, CD4+, CD8+, CD4+/CD8+ were significantly increased in both groups (all P < 0.05), while the serum levels of IL-6, hs-CRP, TNF-α and NT-proBNP were obviously decreased in both groups (all P < 0.05), moreover, the degrees of changes in the above parameters in the TPF-T group were more significant than those in the TPF group [Alb (g/L): 36.91 ±4.49 vs. 36.31 ±3.95, PA (mg/L): 190.26 ±15.39 vs. 188.51 ± 17.62, TRF (g/L): 2.31 ±0.44 vs. 2.25 ±0.71, IL-6 (ng/L): 312.53±42.69 vs. 372.45±51.25, hs-CRP (mg/L): 20.43±15.72 vs. 35.81 ±14.28, TNF-a (ng/L): 81.36± 17.32 vs. 152.67±21.71, CD3+: 0.59±0.06 vs. 0.55±0.05, CD4+: 0.33±0.05 vs. 0.28�
作者
顾南媛
曾龙欢
吕华瑶
Gu Nanyuan;Zeng Longhuan;LV Huayao(Department of Intensive Care Unit, Hangzhou Geriatric Hospital, Hangzhou 310022, Zhejiang, China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2019年第2期163-166,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省医药卫生科技计划项目(2019KY536).
