早期肠内营养对消化道穿孔腹腔感染术后病人炎性指标和蛋白质水平的影响

The effects of early enteral nutrition on IL-6,hs-CRP and prealbumin level in patients with digestive tract perforation after surgical treatment

目的：探讨早期肠内营养（EEN）对消化道穿孔、腹腔感染术后病人白细胞介素-6（IL-6）、超敏C反应蛋白（hs·CRP）、前清蛋白（PA）水平、机械通气时间和入住ICU时间的影响。方法：回顾性分析199例消化道穿孔、严重腹腔感染剖腹探查术后病人，根据EN启动时间分为EEN组（n=123，术后24～36h行EN）、延迟EN组（n=76，术后72h后行EN），观察比较两组病人人院当天和术后第7天IL-6、hs—CRP和PA水平的变化，以及比较两组病人术后机械通气时间和入住ICU时间的差异。结果：两组病人人院当天IL-6、hs．CRP和PA均无显著性差异（P〉0．05）。术后第7天，两组病人IL-6、hs．CRP均较入院当天明显下降，血清PA水平较入院当天明显升高（P〈0．05）。EEN组在术后第7天IL-6、hs—CRP水平明显低于延迟EN组，PA水平明显高于延迟EN组（P〈0．05）。EEN组病人机械通气时间、入住ICU时间明显较延迟EN组缩短（P〈0．05）。结论：EEN较延迟EN可缩短消化道穿孔、腹腔感染术后病人的机械通气时间、入住ICU时间，改善术后IL-6、hs—CRP和PA水平。

Objective： To investigate the effects of early enteral nutrition on IL-6 ,hs-CRP , pre- albumin level, time of ventilation and length of stay in ICU in patients with digestive tract perforation after surgical treatment. Methods： 253 patients with abdominal cavity infection after surgery were retrospec- tively analyzed for the effects of early enteral nutrition. At last, 199 patients included were devided into 2 groups： early enteral group（ n = 123, early enteral nutrition within 24 -36 h） , delayed enteral nutrition group（n =76,EN after 72 h）. The IL-6,hs-CRP, in after surgery were compared between 2 groups. prealbumin level, time of ventilation and length of stay Results ： After a week, the levels of IL-6 and hs-CRP were significantly decreased and prealbumin was significantly increased in early enteral group （P 〈 0.05）. The time of ventilation and length of stay in ICU was also improved significantly in early enteral group （ P 〈 0.05 ）. Conclusion ： Early enteral nutrition can reduce the time of ventilation and length of stay in ICU and improve the levels of IL-6, hs-CRP and prealbumin at first week in patients with digestive tract perforation after surgical treatment.