机械通气患者不同营养方式对感染及免疫功能的影响研究

Study of different nutritional modes on the effect of infection and immune function of patients with mechanical ventilation

目的:探讨不同的营养方式对ICU机械通气患者免疫功能和感染的影响。方法:选取重症医学科2014年10月至2015年10月收治的机械通气患者118例,根据不同营养方式分为肠外营养组(PN)38例,早期肠内营养组(EEN)41例,添加益生菌的早期肠内营养组(PEEN)39例,营养支持治疗时间>14 d,记录3组患者的感染状况及免疫指标。比较3组患者的感染部位、痰培养细菌种类、预后情况、ICU住院天数、机械通气天数和两周机械通气撤机率。结果:营养治疗后14 d,PEEN组患者的白细胞水平低于EEN组及PN组(P<0.05);营养治疗第7、14天PEEN组患者C反应蛋白(CRP)和降钙素原(PCT)水平低于EEN组及PN组(P<0.05);3组患者中性粒细胞百分比在各时相点均无统计学差异(P>0.05);营养治疗第14天PEEN组,EEN组患者Ig A,Ig G,Ig M水平高于PN组(P<0.05);且PEEN组患者较EEN组患者更显著(P<0.05);营养第7、14天,PN组患者的淋巴细胞百分比明显低于EEN组及PEEN组组患者(P<0.05);EEN组及PEEN组患者总感染率低于PN组;三组患者痰培养细菌种类差异无统计学意义(P>0.05)。结论:添加益生菌的肠内营养对机械通气患者在提高机体免疫功能,降低机械通气患者感染发生率方面有一定的积极意义。

Objective： To discuss different nutritional modes on the effect of immune function of patients with ICU mechanical ventilation. Methods： 118 cases of patients with mechanical ventilation hospitalized from October 2014 to October 2015 in Department of ICU of our hospital who were selected,according to the different nutritional methods,they were divided into 38 cases of parenteral nutrition group（ PN）,41 cases of early enteral nutrition（ EEN） group,39 cases of early enteral nutrition group（ PEEN） with probiotics,Nutritional support treatment time 14 d,and the infection status and immune indexes of three groups were recorded. Infection site,sputum culture of bacterial species,prognosis,ICU hospital days,mechanical ventilation days and mechanical ventilation probability of two weeks of patients of three groups were compared. Results： After 14 d of nutritional treatment,the level of white blood cells of patients with PEEN group was lower than that of group EEN and group PN（ P〈 0. 05）; After seventh,14 th day of nutritional treatment,patients with C reactive protein（ CRP） and calcitonin（ PCT） levels of PEEN group were lower than those of the EEN group and PN group（ P 〈0. 05）; There was no significant difference in the percentage of neutrophils of 3 groups（ P〉 0. 05）; Nutritional treatment of PEEN at the fourteenth day,Ig A,Ig G,Ig M levels of patients of EEN group were higher than those of the PN group（ P〈 0. 05）; And patients of PEEN group were more significant than patients of EEN group（ P〈 0. 05）; Nutrition at 7 th day,the 14 th day,The percentage of lymphocytes of PN group was significantly lower than that of group EEN and group PEEN patients（ P〈0. 05）; The total infection rates of patients of group EEN and group PEEN were lower than that of group PN; There was no statistically significant difference in sputum culture of patients between three groups,（ P〉 0. 05）. Conclusion： Enteral nutrition of adding probiotics of patients with mechanical ventilation in improving immune function,and reducing the incidence of infection has a certain positive significance.