添加益生菌的早期肠内营养对危重患者血脂和超敏C反应蛋白水平的影响

Effect of Early Enteral Nutrition with Probiotic on Blood Lipid and Hs-CRP Levels in Critically Ill Patients

目的：探讨添加益生菌的早期肠内营养对危重患者血脂水平和超敏 C 反应蛋白（hs - CRP）水平的影响。方法选取2012年8月—2013年10月新疆医科大学第一附属医院 ICU 收治的危重患者45例，采用随机数字表法将其分为试验组23例和对照组22例。研究期间试验组2例患者自动出院，1例患者生存时间＜7 d 予以剔除，试验组最终实际纳入20例。两组患者均于入 ICU 治疗后24~48 h，且血流动力学稳定后，经鼻胃营养管由营养泵持续泵入肠内营养液瑞素进行营养支持；试验组在此基础上使用益生菌制剂。分别于治疗前、治疗第7天检测两组患者三酰甘油（TG）、总胆固醇、高密度脂蛋白胆固醇（HDL - C）、低密度脂蛋白胆固醇（LDL - C）和 hs - CRP 水平。结果两组患者性别、年龄、体质指数、急性生理与慢性健康状况评分Ⅱ（APACHE Ⅱ）、疾病构成比较，差异均无统计学意义（P ＞0.05）。治疗前，两组患者 TG、总胆固醇、LDL - C、HDL - C 和 hs - CRP 水平比较，差异均无统计学意义（P ＞0.05）；治疗后，两组总胆固醇、LDL - C 比较，差异均无统计学意义（P ＞0.05）；治疗后试验组 TG、hs - CRP 水平低于对照组，HDL - C 高于对照组（P ＜0.05）。结论采用添加益生菌的早期肠内营养方式有助于改善危重患者血脂水平，减轻炎性反应，从而降低患心血管疾病的风险。

Objective To determine the effect of early enteral nutrition with probiotic on blood lipid and high -sensitivity C - reactive protein（ hs - CRP） in critically ill patients in intensive care unit. Methods From August 2012 to October 2013,in the First Affiliated Hospital of Xinjiang Medical University,45 critically ill patients were divided randomly into groups study（n = 23;3 patients were excluded due to leaving hospital without cure or surviving 〈 7 d）,control（ n = 22）. The 2 groups were given nutrition support of enteral nutrient solution by nasogastric feeding tubes,the study group given probiotics based on it at hours 24 - 48 h after ICU treatment. The levels of triglyceride（ TG）,total cholesterol（ TC）,high density lipoprotein cholesterol（ HDL - C）,low density lipoprotein cholesterol（ LDL - C） and hs - CRP were determined before treatment and on days 7 of treatment. Results There was no significant difference in gender,age,BMI,APACHE Ⅱ, disease constitution between 2 groups（P 〉 0. 05）,no in levels of TG,TC,LDL - C,HDL - C,hs - CRP before treatment （P 〉 0. 05）,and no in TC,LDL - C after treatment（P 〉 0. 05）,the levels of TG,hs - CRP were lower,HDL - C higher in study group than in control group（P 〈 0. 05）. Conclusion Enteral nutrition with probiotics is conducive to improving blood lipid level in critically ill patients and can reduce inflammation,thereby to decrease the risks of cardiovascular diseases.