早期肠内营养对严重创伤患者多器官功能障碍综合征发生率的影响

Effect of early enteral nutrition on the morbidity of multple organ dysfunction syndrome in severe trauma patients： study of 102 cases

目的 探讨早期肠内营养对严重创伤患者多器官功能障碍综合征（MODS）发生率的影响。方法严重创伤患者102例随机均分为治疗组和对照组。治疗组采用肠外肠内序贯营养支持治疗，第1d予半量的肠外营养（PN）和肠内营养（EN）。PN和EN序贯营养支持的积极治疗策略，即早期（第1d）以PN给予50％能量需求量，继之以EN（第2d始），逐步增加肠内营养量，最终（第8d）过渡到全肠内营养（TEN），从而避免了EN的一些严重并发症，使EEN得以顺利实施的方法，实行早期肠内营养。对照组按传统方法进行营养支持。观察患者MODS发生率。观察治疗前后患者血淋巴细胞、免疫球蛋白、CRP、TNF-α、IL-1水平变化。结果对照组MODS发生率为13．7％，显著低于对照组（31．4％，P〈0．05）。营养支持第14d、21d，治疗组血淋巴细胞、免疫球蛋白显著高于对照组（均P〈0．05）；血CRP、TNF-α和IL-1显著低于对照组（均P〈0．05）。结论早期肠内营养能增加肠内营养总量，提高严重创伤患者机体免疫力，减轻炎症反应，从而减少MODS发生率。

Objective To investigate the effect of early enteral nutrition （EEN） on the morbidity of multple organ dysfunction syndrome （MODS） in severe trauma patients. Methods 102 patients with severe trauma were randomly diveded into 2 equal groups： experimental group and control group. In the exterimental group sequential supporting dietotherapy with parenteral nutrition （PN） and enteral nutrition （EN） was conducted： PN was conducted to provide 50% of the resting energy expenditure （REE） on days 1- 3 and then provide 25% of the REE on days 4-7, since day 2 EN was added to provide 25% of REE till day 4 and then provide 50% of REE till day 7, and since day 8 only total enteral nutrition was given. On days 1, 7, 14, and 21 venous blood samples were collected to examine the levels of blood lymphocyte, immunoglobulin, C-reaction protein （CRP）, tumor necrosis factor-α （TNF-α）, and interleukin-1 （IL-1）. The incidence of MODS was obseved. Results The morbidity of MODS of ther experimental group was 13.7%, significantly lower than that of the control group （31.4%, P〈0.05）. On the days 14 and 21, the levels of blood lymphocyte and immunoglobulin of the experimental group were both significantly higher, and the levels of CRP, TNF-α, and IL-1 of the experimental group were all significantly lower than those of the contyrol goup （all P〈0.05）. Conlussion EEN increases the whole enteral nutrition volume dose, improves the severe trauma patients＇ immunity releases inflammatory reaction, thus reducing the morbidity of MoDS.