肠内营养对外科危重患者肠屏障功能的影响

Influence of enteral nutrition on intestinal mucous membrane barrier function in critical patients of surgical departments

目的探讨外科危重患者肠屏障功能(IMB)的损害及肠内营养支持(EN)的维护作用。方法选择2010年4月-2014年6月该院收治的外科危重患者47例为研究对象。在治疗原发病并恢复有效血容量后,给予全静脉营养(PN),其中25例联合EN支持。两组治疗10 d后检测外周血内毒素、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平。治疗14 d后观察血红蛋白(Hb)、血清白蛋白(ALB)、血清胆固醇(CHO)水平。结果PN+EN组血内毒素、CRP、TNF-α低于PN组,差异有统计学意义(t=3.354、9.598和5.559,P<0.01);PN+EN组Hb、ALB、CHO高于PN组,差异有统计学意义(t=2.761、2.144和2.586,P<0.05)。结论 EN支持可有效改善危重患者IMB功能。

【Objective】 To discuss the functionality of the intestinal mucous membrane barrier and the enteral nutrition（EN） support in patients in critical condition.【Methods】 Forty-seven patients with acute pancreatitis in critical condition admitted to the hospital from Apr. 2010 to Jun. 2014 were enrolled into this study. After treating the primary diseases and restoring healthy blood volume, the patients were treated with parenteral nutrition（PN）. Among them 25 were also treated with intestinal nutrition support（PN＋EN）. After 10 days of treatment, blood endotoxin, C-reactive protein（CRP） and tumor necrosis factor-α（TNF-α） levels were measured. After 14 days, Hb, serum ALB and CHO levels were monitored. 【Results】 The patients of the PN＋EN group had significantly higher blood endotoxin, CRP and TNF-αlevels than those of the PN group（t =3.354, 9.598 and 5.559, P 〈0.01）. The PN＋EN group also had significantly higher Hb, ALB and CHO than the PN group（t = 2.761, 2.144 and 2.586, P 〈0.05）. 【Conclusion】 The enteral nutrition effectively improves intestinal barrier function in patients in critical condition.