重度烧伤患者早期肠内免疫营养对机体免疫功能的影响及护理

Effect of early enteral immunonutrition on immune function and care in severe burn patients

目的探讨重度烧伤患者早期肠内免疫营养对机体及肠道免疫功能的影响,并总结护理要点。方法选择本院收治的重度烧伤患者40例,随机分为研究组与对照组,各20例,研究组患者给予肠内免疫营养液进行营养支持,对照组患者给予常规营养液进行营养支持,两组均给予综合护理。比较两组营养支持第1、3、5、7天时T细胞亚群及血清免疫球蛋白的变化情况。结果对照组营养治疗第3、5、7天时CD3+、CD4+、CD8+、CD4+/CD8+均较第1天降低,而研究组患者治疗第3、5天时上述指标明显升高,第7天时较第1天无明显变化,两组第3、5、7天时CD3+、CD4+、CD8+、CD4+/CD8+比较,差异有统计学意义(P<0.05)。营养治疗第3、5、7天两组血清免疫球蛋白IgM、IgA、IgG均降低,但是研究组明显高于对照组,两组差异有统计学意义(P<0.05)。采用免疫营养支持的研究组患者存活率、脓毒症发生率及创面愈合时间明显优于对照组,差异有统计学意义(P<0.05)。结论重度烧伤患者肠内免疫营养支持,配合综合护理,可改善机体免疫功能,缩短创面愈合时间,提高存活率,效果良好,值得应用。

Objective To investigate effect of early enteral immunonutrition on immune function and care in severe burn patients and summarize the care points. Methods 40 cases of severe burn patients in our hospital were randomly divided into study group and control group, 20 cases in each group, patients in the study group were given enteral immunonutrition liquid nutritional support, patients in the control group were treated with conventional nutrition for nutritional support. The two groups were all given comprehensive care. The changes of nutritional support for 1st, 3rd, 5th and 7th days of T-cell subsets and serum immunoglobulin of two groups were compared. Results CD3＋, CD4＋, CD8＋ and CD4＋/CD8＋ of the control group with the nutrition therapy in the 3rd, 5th and 7th days reduced compared with the first day, the above parameters of the study group in the 3rd, 5th days were significantly increased, while there were no significant changes in the 7th day compared with the first day. CD3＋, CD4＋, CD8＋ and CD4＋/CD8＋ of the two groups in the 3rd, 5th and 7th days had statistically significant differences （P 〈 0.05）. Serum levels of immunoglobulin IgM, IgA and IgG of study group decreased in the 3rd, 5th and 7th days, but the study group was significantly higher, the difference was statistically significant （P 〈 0.05）. Survival rate, sepsis rate and wound healing time of the study group with immune and nutritional support were better than that of the control group, the difference was statistically significant （P 〈 0.05）. Conclusion Severe burn patients with enteral immunonutrition support with integrated care can improve immune function, and decrease wound healing time, increase the survival rate, the effect is well worthy of application.