严重多发伤患者伤后早期免疫肠内营养支持的应用

Effect of immune enteral nutrition support on the patients in early stage after severe multiple injury

目的探究严重多发伤后早期免疫肠内营养支持对患者营养状况及免疫功能的恢复作用。方法华中科技大学同济医学院附属同济医院创伤外科2006年1月至2007年5月间收治的40例严重多发伤患者随机分成两组：免疫肠内营养组（IEN组）20例，行免疫肠内营养支持；肠内营养组（EN组）20例，行常规肠内营养支持。以健康人为对照组，15例。各组患者于伤后1d开始营养支持，伤后1d、3d,5d、8d检测外周血T细胞亚群及血清中PA、RBP、IL-2、IL-4浓度。结果IEN及EN支持8d后，患者的T细胞亚群以及血清蛋白PA、RBP较伤后1d有极显著增高（P〈0．01），但IEN组与EN组问相比差异无统计学意义。两组患者的IL-2浓度在伤后8d均较伤后1d有显著增高（P〈0．01），IEN组增高较EN组更显著（P〈0．05）；在伤后8d，IEN组IL-4的浓度下降明显且与EN组相比差异具有统计学意义（P〈0．05）。与EN组相比，IEN组患者的SIRS持续时间短及感染并发症率低。结论在改善患者免疫抑制状态及提高创伤患者临床预后方面，IEN要较EN更有优势。

Objective To explore the recuperative effect of immunological function and nutritional status on the patients treated by immune enteral nutrition in early stage after severe multiple injury （SMI）. Method The patients with SMI, in department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2006 to May 2007 were randomly divided into 2 groups： immune enteral nutrition group （ IEN group, 20 cases）, enteral nutrition group （ EN group, 20 eases）. The health persons served as the control group（ 15 cases）. Since lst postinjury day, all patients were treated with nutritional support. The T-cell subgroup in periphera blood were detected by FCM and the level of PA, RBP, IL-2 and IL-4 in blood senan were detected by ELASA on the 1st, 3rd, 5th, 8th postinjury day. Results After the treatment of IEN and EN, the serum levels of PA, RBP and the proportion of T-cell subgroup were significantly increased on the 8th postinjury day compared with on 1^st postinjury day （ P 〈 0.01 ）, but there were no differences between IEN group and EN group. The level of IL-4 were significantly decreased and the level of IL-2 were significantly increased in each group on 8th postinjury day, at same time, the level of IL-2 were significantly increased in IEN group compared with EN group （ P 〈 0. 05）, and the level of IL-4 were significantly decreased in IEN group compared with EN group （ P 〈 0.05）. The duration of SIRS was transient and the infected complication was low on the patients treatment by IEN than EN. Conclusions On the patients with severe multiple injury, IEN was most ascendant than EN to improve the and clinical prognosis.