不同营养支持模式对重症社区获得性肺炎预后的影响

Effect of different nutritional support on the prognosis of severe community-acquired pneumonia

目的通过不同脂肪含量营养支持干预重症社区获得性肺炎(severe community-acquired pneumonia,SCAP)患者,探讨其转归。方法选择2014年1月—2015年7月收治的90例存在营养风险的SCAP患者,采用随机数字表法将其分为高脂肪含量组、正常脂肪含量组和低脂肪含量组,每组各30例。所有患者均在常规给予抗菌药物、祛痰药物等治疗的基础上,分别给予不同脂肪含量的营养支持。比较各组患者治疗前及治疗第10天血清白蛋白、前白蛋白、转铁蛋白、住院时间及预后情况。结果治疗前各组白蛋白、前白蛋白和转铁蛋白比较,差异均无统计学意义(P>0.05)。治疗第10天,各组血清白蛋白、前白蛋白和转铁蛋白水平均高于该组治疗前,差异有统计学意义(P<0.05);正常脂肪含量组患者较其他两组患者各项指标改善更显著,差异有统计学意义(P<0.05)。正常脂肪含量组的住院时间明显缩短,但各组间比较差异无统计学意义(P>0.05)。正常营养组的治愈率明显高于高脂肪含量组和低脂肪含量组,病死率明显低于高脂肪含量组和低脂肪含量组,差异有统计学意义(P<0.05);各组好转率比较差异无统计学意义(P>0.05)。结论对SCAP患者给予正常脂肪含量的营养支持,可较快改善其血清白蛋白、前白蛋白及转铁蛋白水平,缩短其住院时间,预后更好,值得临床推广。

Objective To investigate the clinical efficacy of nutritional support with different proportion of fat on the prognosis of patients with severe community-acquired pneumonia（SCAP）. Methods Ninety SCAP patients with nutritional risk treated between January 2014 and July 2015 were randomized into high, normal, and low-proportion fat groups with 30 patients in each. The patients in different groups underwent nutritional support with different fat proportion besides the same medication. Data of albumin, pre-albumin and transferrin were collected and analyzed before treatment and 10 days after treatment. The mortality rates were compared between groups. Results Albumin, prealbumin and transferrin were similar in all groups before intervention（P〉0.05）; albumin, pre-albumin and transferrin increased significantly 10 days after treatment in each group（P〈0.05）. Patients in the normal-fat group acquired significantly more obvious improvements on each index（P〈0.05）. A shorter length of stay in hospital was observed in the normal-proportion fat group compared with the high and low-proportion fat groups, but there was no significant differences among groups（P〉0.05）. On the 10 th day, the normal-proportion fat proportion group had a significantly higher cure rate and a significantly lower mortality rate than the other two groups（P〈0.05）. The improvement rate was similar in all groups（P〉0.05）. Conclusion Supportive treatment with normal fat proportion has a promising value in the improvement of albumin, pre-albumin and transferrin for SCAP patients with a shorter length of stay in hospital, which is worthy of clinical promotion.