早期肠内营养应用对严重腹部外伤患者营养状态和肠屏蔽功能的临床研究

Clinical trial of early enteral nutrition on nutritional status and intestinal shielding function in patients with severe abdominal trauma

目的评价早期肠内营养支持对严重腹部创伤术后患者的营养状态及肠屏障功能的影响。方法入选56例严重腹部外伤患者,随机分为试验组和对照组,每组28例。2组均于术中进行空肠造瘘术,试验组在术后24 h内给予早期肠内营养支持,对照组于术后先行输液处理,72 h后转为肠内营养支持。测定并比较2组患者治疗前后营养指标(血清白蛋白、前白蛋白、转铁蛋白)、免疫细胞因子(CD3+、CD4+、CD8+)以及肠粘膜功能(血浆脂多糖、D-乳酸浓度、尿乳果糖/甘露醇)变化。结果治疗后,2组血清白蛋白、前白蛋白、转铁蛋白、CD3+、CD4+、CD8+、脂多糖、D-乳酸浓度、尿乳果糖/甘露醇均较治疗前明显改善,试验组改善程度更明显(P<0.05)。试验组不良反应发生率为7.14%,明显低于对照组的28.57%(P<0.05)。结论严重腹部外伤术后早期给予肠内营养支持能够起到更好的疗效,更有利于胃肠道功能的恢复,改善营养状况。

Objective To explore the effects of early enteral nutrition on nutritional status and intestinal shielding function in patients with severe abdominal trauma. Methods A total of 56 cases of severe abdominal trauma patients in our hospital were randomly divided into trial group and control group,28 cases in each group. Both groups underwent jejunostomy during operation,trial group was given postoperative early enteral nutrition support within 24 h,control group were received intravenous infusion firstly,and then received delayed enteral nutrition 72 h after operation. The nutritional status index（ serum albumin,prealbumin and transferrin）,immune function index（ CD3＋、CD4＋、CD8＋） and changes of intestinal mucosal functions（ lipopolysaccharide,D- lactic acid concentration,urinary lactulose / mannitol ratio） were compared before and after treatment in 2 groups. Results Compared with those before treatment,the serum albumin,prealbumin,transferrin,CD3＋,CD4＋,CD8＋,lipopolysaccharide,D- lactic acid concentration,urinary lactulose / mannitol ratio index significantly improved in both groups after treatment,the trial group improved more significantly（ P〈0. 05）. The rate of adverse drug reaction in trail group was 7. 14%,significantly lower than that of control group（ 28. 57%,P〈0. 05）. Conclusion After severeabdominal trauma,early enteral nutrition support has a better effect compared to delayed enteral nutrition support,which is more conducive to the recovery of gastrointestinal function and the improvement of nutritional status.