早期TEN和TPN对创伤后免疫和代谢的影响

Influence of Total Early Enteral vs Total Parenteral Nutrition to the Immune and Metabolic Function of Patient with Multiple Traumas

目的观察创伤后早期肠内和肠外营养对机体免疫和代谢功能的影响。 方法对复合伤患者进行早期肠内或肠外营养支持 ,观察患者营养支持前后代谢和免疫指标的变化。 结果较之肠外营养 ,肠内营养组营养前后前白蛋白变化明显 ,淋巴细胞增殖率增加显著。而肠外营养组每日氮损失量明显小于肠内营养组。两组间免疫球蛋白和T细胞亚群变化无明显差异。 结论创伤后早期肠内营养支持可促进机体免疫功能恢复 ,减少并发症发生率。而肠外营养更有利于纠正负氮平衡。

Objective To investigate the effects of total enteral nutrition (TEN) vs. total parenteral nutrition (TPN) on protein metabolism, T lymphocyte subsets and immune function of patient with major injuries. Methods Fifty two multiple trauma patients were randomized to isocaloric feeding of TEN or TPN for 7d. Traditional nutritional protein markers (albumin, transferrin and prealbumin), immunoglobulin, T lymphocyte subsets, PHA stimulated lymphocyte proliferation, natural killer cell activity and nitrogen balance were measured before and after nutritional support. Results Prealbumin and PHA stimulated lymphocyte proliferation were restored better in the TEN group, and fewer TEN patients experienced septic complications. How ever, similar improvements in immunoglobulin and T lymphocyte subsets of both groups were observed. But nitrogen balance data consistently favored the TPN group. Conclusion The results of these studies indicate that early TEN can restore the immune function and reduce septic complications better than TPN, but TPN seemed more efficiency in keeping nitrogen balance.