周期性与持续性营养输注方式对呼吸衰竭机械通气患者血清炎症因子的影响——附30例报告

Effect of cyclic or continuous nutrition infusion on serum inflammatory factors in the patients with respiratory failure treated by mechanical ventilation

目的:观察周期性与持续性营养输注方式对内科呼吸衰竭机械通气患者血清TNF-α、白介素-6的影响。方法:30例呼吸衰竭机械通气患者,随机分为甲、乙2组,进行交叉的自身对照研究。在调节患者营养达目标量[125～146kJ/(kg.d)]后,保持营养物质成分不变,甲组先行24h持续周期性营养输注7d,经3d洗脱期后改为16h周期性输注7d;乙组先行16h周期性营养输注7d,经3d洗脱期后改为24h持续输注7d。分别于患者入组时、观察第7日(阶段1)及交叉后第7日(阶段2)测定患者血清TNF-α、白介素-6水平,并按营养输注方式将数据分为持续输注组及周期输注组,比较其差异。结果:30例入组时TNF-α水平为56～75(60)ng/L,持续输注组2个阶段合计为51～59(53)ng/L,周期输注组2个阶段合计为51～64(57)ng/L。2组的TNF-α水平与入组时比较差异均有统计学意义(均为P<0.05)。30例入组时的白介素-6水平为33～88(64)ng/L,持续输注组2个阶段合计为19～66(47)ng/L,周期输注组2个阶段合计为28～99(57)ng/L。2组的白介素-6水平与入组时比较差异均有统计学意义(均为P<0.05)。持续输注组的TNF-α、白介素-6水平均低于周期输注组(均为P<0.05)。阶段1与阶段2的TNF-α水平比较差异无统计学意义(P>0.05),阶段1与阶段2的白介素-6水平比较差异亦无统计学意义(P>0.05)。结论:呼吸衰竭机械通气患者应用24h持续性营养输注方式时血清TNF-α及白介素-6水平较低,24h持续性营养输注可能有助于改善其临床预后。

Objective： To investigate the different effects of cyclic or continuous nutrition transfusion on serum inflammatory factors in the patients with respiratory failure treated by mechanical ventilation. Methods： Thirty patients with respiratory failure treated by mechanical ventilation were enrolled, which were divide into group A and group B, observed by cross-over and own control trial. First, the total nutrition calorie was adjusted to the target of 125 - 146 kJ/（kg·d）. Group A received continuous 24 hours uniform nutrition infusion for 7 days （ phase 1）, then received 16 hours cyclic infusion for 7 days （ phase 2） after 3 days of elution. Group B firstly received 16 hours cyclic nutrition infusion for 7 days （ phase 1 ）, then received continuous 24 hours nutrition infusion for 7 days （ phase 2） after 3 days of elution. Serum levels of TNF-α and IL-6 were detected respectively in the day enrolled, the 7th day in phase 1 and 7th day in phase 2. All data were divided into group continuous infusion and group cyclic infusion and differences between the two groups were compared. Results： The levels of TNF-α of these patients in the day enrolled were 56-75 （60） ng/L. The levels of TNF-α in the continuous infusion group were 51-59 （53）ng/L, and were 51-64 （57） ng/L in the cyclic infusion group, both of which were significantly lower than the initial levels （P 〈 0.05, in each）. The IL-6 levels of these patients in the day enrolled were 33-88（64） ng/L. The levels of IL-6 in the continuous infusion group were 19-66 （47） ng/L, and were 28-99 （57） ng/L in the cyclic infusion group, both of which were significantly lower than the initial levels （P 〈 0. 05, in each）. The levels of TNF-α and IL-6 in continuous infusion group were significantly lower than cyclic infusion group （P 〈 0. 05, in each）. The differences of TNF-α and IL-6 levels in two stages were not statistically signifi- cant （P 〉 0. 05 ）. Conclusion： The levels of serum TNF-α and IL-6 of 24-hour continuous infusion were lower than those of 16-hour cyclic infusion in the patients with reslairatorv failure treated by mechanical ventilation, and 24-hour continuous infusion can possibly improve clinical outcome.