不同营养支持对危重病患者NF-κB活性的影响及药物经济学分析

Effects of Different Nutrition Support on Activity of Nuclear Factor-κB in Critically Ill Patients and Drug Economic Analysis

目的:探讨不同营养方式对危重病患者NF-κB活性、IL-1和IL-8水平的影响,观察并发症并进行药物经济学分析。方法:80例危重病患者分为研究A组和B组。每组各40例。40名健康体检者为正常对照组。A组采用肠内营养+肠外营养联合营养方式。B组采用全肠外营养支持,两组患者经计算等热量等氮补充。营养支持前1d及营养支持后第10天,抽取外周静脉血,ELIAS法检测外周血单个核细胞NF-κB活性,血浆IL-1和IL-8的水平。观察两组并发症及死亡率,并进行药物经济学分析。结果:营养支持前A组和B组患者NF-κB活性、IL-1和IL-8水平明显高于正常组(P<0.05);营养支持前A组及B组患者NF-κB活性、IL-1和IL-8水平,无明显差异(P>0.05);营养支持后第10d,A组及B组患者的NF-κB活性、IL-1和IL-8水平明显下降,与营养支持前比较有明显差异(P<0.05);A组和B组比较,A组下降明显(P<0.05)。A组患者并发症发生率少于B组患者(P<0.05)。A组死亡率为30.0%,B组死亡率为32.5%,两者相比无明显差异(P>0.05)A组患者平均每天用于营养支持的费用明显少于B组患者(P<0.05)。结论:危重病患者通常存在炎症过度反应。肠内+肠外营养联合营养方式更能降低危重患者的炎症反应,并发症少,有较高的经济学效益。

Objective： To investigate the effects of different nutrition support style on activity of nuclear factor-κB,the levels of IL-1 and IL-8 in critically ill patients.At the same time,the complications were observed and drug economics benefits were analysed.Method： 80 critically ill patients were divided into the trial group（group A） and the control group（group B）.Each group with 40 patients.40 health subjects with medical check-up were included in the normal group.Group A were treated with EN＋PN.Group B were treated with standard TPN.Two groups were supplied with equal nitrogen and caloricity.The activity of NF-κB,the level of IL-1 and IL-8 were detected before and after treatment.The control and trial groups were followed up for 28 days,and the mortality and complications were observed.Drug economics benefits of two groups were analysed.Result： The activity of NF-κB,the levels of IL-1 and IL-8 in critically ill patients were significantly higher than those in normal group（P0.05）.The activity of NF-κB,the level of IL-1 and IL-8 were not significant different between group A and group B before treatment（P0.05）.The activity of NF-κB,the level of IL-1 and IL-8 in two groups after treatment were significantly lower than those before treatment（P0.05）.The activity of NF-κB,the level of IL-1 and IL-8 in group A after treatment were lower than those in group B after treatment（P0.05）.The rate of complication in group A was lower than group B（P0.05）.The cost that was used for nutrition support average every day in group A was lover than group B（P0.05）.The mortality in group A was 30.0%,and the mortality in group B was 32.5%.The difference was not obvious（P0.05）.Conclusion： The critically ill patients have the characteristic of inflammatory reaction disorder.The EN＋PN nutrition support can decrease the inflammatory mediators of critically ill patients,alleviate the inflammatory reaction.It also decrease the rate of complication and has high economic effect.