外科ICU患者肠内营养支持疗法对患者感染情况和免疫功能的影响

Influence of enteral nutrition support therapy on prevalence of infections and immune function of the ICU patients of surgery department

目的分析外科ICU患者肠内营养支持疗法对患者感染情况和免疫功能的影响,为患者营养支持方式的选取提供依据。方法选取2015年12月-2017年1月医院收治的68例外科ICU患者为研究对象,根据营养支持方式的不同将患者分为对照组(肠外营养支持组)34例和试验组(肠内营养支持组)34例;对两组患者的医院感染率、营养支持前后的细胞免疫指标(CD3^+、CD4^+、CD3^+CD4^+及NK)、体液免疫(IgA、IgM及IgG)及红细胞免疫指标(FEER、ATER、DTER及RBC-C3bR)水平进行比较。结果试验组的感染率为2.94%,低于对照组(P<0.05),治疗前两组患者的细胞免疫、体液免疫及红细胞免疫指标水平差异均无统计学意义,而营养支持治疗后7d及14d试验组的细胞免疫(CD3^+、CD4^+、CD3^+CD4^+及NK)分别为(63.23±5.08)%、(45.30±4.24)%、(32.25±3.41)%、(16.49±1.75)%及(67.63±5.23)%、(49.24±4.56)%、(35.25±3.66)%、(18.98±2.01)%,体液免疫(IgA、IgM及IgG)水平分别为(3.03±0.27)g/L、(2.20±0.20)g/L、(12.26±1.50)g/L及(3.24±0.31)g/L、(2.53±0.24)g/L、(14.17±1.59)g/L,红细胞免疫指标(FEER、ATER、DTER及RBC-C3bR)水平分别为(53.20±5.10)%、(56.20±4.98)%、(32.98±3.10)%、(18.98±2.07)%及(56.56±5.32)%、(59.73±5.10)%、(36.56±3.34)%、(21.24±2.25)%,均高于对照组,差异有统计学意义(P<0.05)。结论外科ICU肠内营养支持治疗有助于外科ICU患者感染的控制,且对患者的机体免疫功能也有改善作用,因此应用意义较大。

OBJECTIVE To observe the influence of enteral nutrition support therapy on prevalence of infections and immune function of the ICU patients of surgery department so as to provide guidance for the enteral nutrition sup- port therapy.METHODS A total of 68 ICU patients of surgery department who were treated in the hospital from Dec 2015 to Jan 2017 were recruited as the study objects and divided into the control group （the parenteral nutri- tion group） with 34 cases and the observation group （the enteral nutrition group） with 34 groups according to the nutrition support approach. The incidence of nosocomiat infections, cellular immunity indexes （CD8 ＋ , CD4 ＋ , CD8 ＋CD4＋ and NK）, humoral immunity indexes （IgA, IgM and IgG） and erythrocyte immune indexes （FEER, ATER, DTER and RBC-C3bR） were observed and compared between the two groups of patients.RESULTS The infection rate of the observation group was 2.94%, significantly lower than 17.65% of the control group （P 〈0.05）.There were no significant differences in the cellular immunity indexes, humoral immunity indexes or eryth- rocyte immune indexes between the two groups of patients before the treatments the levels of the cellular immuni- ty indexes CD3 ＋ , CD4 ＋ , CD3 ＋ CD4 ＋ and NK of the observation group were respectively （63.23 ± 5.08） %, （45.30±4.24）%, （32.25±3.41）% and （16.49＋1.75）% after the nutrition support therapy for 7 days and wererespectively （67.63±5.23）%, （49.24±4.56）%, （35.25±3.66）% and （18.98±2.01）% after nutrition support therapy for 14 days; the levels of the humoral immunity indexes IgA, IgM and IgG of the observation group were respectively （3.03±0.27）g/L, （2.20±0.20）g/L and （12.26±1.50）g/L after the nutrition support therapy {or 7 days and were respectively （3.24±0.31）g/L, （2.53±0.24）g/L and （14.17±1.59）g/L after the nutrition support therapy for 14 days~ the levels of the erythrocyte immune indexes FEER, ATER, DTER and RBC-C3bR of the observation group were respectively （53.20±5.10）%, （56.20±4.98）%, （32.98±3.10）% and（18.98±2.07）% after the nutrition therapy for 7 days and were respectively （56.56±5.32）%, （59.73±5.10）%, （36.56±3.34）% and （21.24±2.25）% after the nutrition support therapy for 14 days, significantly higher than that of the control group（P〈0.05）.CONCLUSION The enteral nutrition support therapy may facilliate the control of the infections in the ICU patients of surgery department and improve the immune function indexes of the patients, and it has great application significance.