儿童早期肠内营养联合益生菌治疗机械通气疗效及安全性研究

Efficacy and safety of early enteral nutrition combined with probiotics in treatment of children on mechanical ventilation

目的:研究早期肠内营养联合益生菌治疗机械通气儿童的疗效及安全性。方法:根据患儿营养支持方式将机械通气患儿分为全静脉营养组(TPN组)、早期肠内营养组(EEN组)和早期肠内营养联合益生菌组(P+EEN组),比较三组患儿疗效、并发症及治疗前、治疗后营养指标、炎症因子及免疫功能的差异。结果:P+EEN组机械通气患儿ICU入住时间、机械通气时间、住院时间、死亡率、继发感染率和肝肾功能损害率均低于TPN组和EEN组机械通气患儿(P <0.05)。TPN组、EEN组和P+EEN组机械通气患儿治疗前PA、ALB、TP、IgG、IgA、IgM、WBC、hs-CRP、PCT、CD3^+、CD4^+和CD8^+的差异均无统计学意义(P> 0.05),P+EEN组机械通气患儿治疗后WBC、hs-CRP和PCT均低于TPN组和EEN组机械通气患儿,而PA、ALB、TP、IgG、IgA、IgM、CD3^+、CD4^+和CD8^+均高于TPN组和EEN组机械通气患儿,差异均具有统计学意义(P <0.05)。结论:早期肠内营养联合益生菌可明显改善机械通气患儿营养状况、免疫功能及预后,不增加并发症发生率。

Objective: To investigate the efficacy and safety of early enteral nutrition (EEN) combined with probiotics in the treatment of children on mechanical ventilation. Methods: Children on mechanical ventilation were di? vided into total parenteral nutrition (TPN) group, EEN group, and probiotics+EEN (P+EEN) group according their nu? tritional support. The treatment outcomes, complications, nutritional indices before and after treatment, inflammatory factors, and immune function were compared between the three groups. Results: The P+EEN group had significantly shorter length of intensive care unit stay, mechanical ventilation time, and length of hospital stay and significantly lower mortality rate, secondary infection rate, rate of liver dysfunction, and rate of renal dysfunction compared with the TPN group and the EEN group (all P < 0.05). Before treatment, there were no significant differences in the levels of prealbumin (PA), albumin (ALB), total protein (TP), immunoglobulin G (IgG), immunoglobulin A (IgA), immuno? globulin M (IgM), and high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), plateletcrit (PCT), and the percentages of CD3+, CD4+, and CD8+ T cells between the TPN group, the EEN group, and the P+EEN group (all P >0.05). After treatment, the P+EEN group had significantly lower WBC, PCT, and level of hs-CRP and significantly higher levels of PA, ALB, TP, IgG, IgA, and IgM and percentages of CD3+, CD4+, and CD8+ T cells com? pared with the TPN group and the EEN group (all P < 0.05). Conclusion: For children on mechanical ventilation, early enteral nutrition combined with probiotics can significantly improve the nutritional status, immune function, and prognosis, and does not significantly increase the incidence of complications.