摘要
目的探讨早期肠内营养对老年脓毒症患者肠黏膜屏障、炎症因子及预后的影响。方法在常规综合治疗的基础上,60例老年脓毒症患者随机均分为24 h内给予早期肠内营养(EEN组)和48 h后给予延迟肠内营养(DEN组)两组。比较两组肠内营养治疗第1天和第7天肠黏膜屏障指标、炎症因子水平和ICU住院时间以及28 d病死率。结果行肠内营养治疗第1天,两组肠脂肪酸结合蛋白(IFABP)、二胺氧化酶(DAO)、D乳酸(D-Lac)、血清降钙素原(PCT)、CRP、IL-6和TNF-α水平差异无统计学意义(P>0.05)。与行肠内营养治疗第1天比较,两组第7天IFABP、DAO、D-Lac、PCT、CRP、IL-6和TNF-α水平均下降(P<0.05),EEN组较DEN组下降更明显(P<0.05)。EEN组患者入住ICU天数短于DEN组[(11.5±3.7)d vs.(14.8±4.2)d](P<0.05)。EEN组患者28 d病死率稍低于DEN组(3.3%vs.6.7%)(P>0.05)。结论与延迟肠内营养比较,早期肠内营养有利于更好地修复老年脓毒症患者肠黏膜屏障,减少炎症因子释放,缩短ICU住院时间。
Objective To study the effects of early enteral nutrition on intestinal mucosal barrier,inflammatory factors and prognosis in elderly patients with sepsis.Methods On the basis of conventional comprehensive treatment,60 elderly patients with sepsis were equally randomized into two groups and treated with enteral nutrition started within 24 hours(group EEN)or at 48 hours later(group DEN).The levels of intestinal mucosal barrier markers and inflammatory factors,ICU stay and 28-day mortality were compared between the two groups.Results There were no significant differences in the levels of intestinal fatty acid binding protein,diamineoxidase,D lactic acid,serum calmodulin,CRP,IL-6 and TNF-αbetween the two groups on the 1^st day after enteral nutrition therapy(P>0.05),which were significantly lower on the 7^th day than those on the 1^st day after enteral nutrition therapy(P<0.05).The decrease of those indicators on the 7^th day after enteral nutrition therapy was more in group EEN than that in group DEN(P<0.05).The ICU stay time was shorter in group EEN than that in group DEN[(11.5±3.7)days vs.(14.8±4.2)days](P<0.05).The 28-day mortality of group EEN was slightly lower than that of group DEN(3.3%vs.6.7%)(P>0.05).Conclusion Compared with delayed enteral nutrition,the early enteral nutrition is beneficial to improving the repair of the intestinal mucosa barrier in the elderly patients with sepsis,reducing the release of the inflammatory factors,and shortening the time of ICU stay.
作者
高薇薇
阚建英
于乃浩
GAO Weiwei;KAN Jianying;YU Naihao(Intensive Care Unit,Affiliated Hospital,Tianjin Academy of Traditional Chinese Medicine,Tianjin 300120,CHINA)
出处
《江苏医药》
CAS
2019年第11期1132-1135,共4页
Jiangsu Medical Journal
基金
天津市卫生和计划生育委员会中医中西医结合科研课题(2017022)
关键词
肠内营养
脓毒症
肠黏膜屏障
炎症因子
老年
Enteral nutrition
Sepsis
Intestinal mucosal barrier
Inflammatory factors
Geriatrics
