术后早期肠内生态免疫营养在腹腔感染营养支持治疗中应用价值的前瞻性研究

Application value of early postoperative enteral eco-immune nutrition in the nutritional support treatment for intra-abdominal infection: a prospective analysis

目的:探讨术后早期肠内生态免疫营养在腹腔感染营养支持治疗中的应用价值。方法:采用前瞻性研究方法。选取2018年2—12月中国人民解放军联勤保障部队第九四○医院收治的62例腹腔感染患者的临床病理资料。采用信封法将患者随机分为两组(盲法为双盲法)。患者术后24~48 h开始给予生态免疫肠内营养制剂,设为生态免疫组;患者术后24~48 h开始给予单纯肠内营养制剂,设为单纯组。观察指标:(1)两组患者治疗前和治疗7 d后免疫功能指标分析。(2)两组患者术后情况分析。(3)随访情况。采用电话方式进行随访,了解患者并发症和再发感染情况。随访时间截至2019年5月。正态分布的计量资料以Mean±SD表示,组内、组间比较采用t检验。计数资料以绝对数或百分比表示,组间比较采用χ2检验。结果:筛选出符合条件的患者62例,男38例,女24例;年龄为(54±14)岁,年龄范围为22~81岁。62例患者中,生态免疫组30例、单纯组32例。(1)两组患者治疗前和治疗7 d后免疫功能相关指标分析:治疗前,生态免疫组患者CD3+、CD4+、CD8+、CD4+/CD8+、自然杀伤(NK)细胞计数、血浆内毒素、免疫球蛋白(Ig)A水平分别为61%±12%、34%±5%、28%±5%、1.25±0.34、17.26%±2.74%、(2.4±0.3)ng/L、(1.7±0.5)g/L;单纯组上述指标分别为59%±11%、33%±5%、27%±4%、1.27±0.36、16.96%±2.99%、(2.5±0.5)ng/L、(1.8±0.5)g/L。治疗7 d后,生态免疫组患者上述指标分别为62%±8%、37%±6%、27%±8%、1.45±0.32、22.63%±7.25%、(2.2±0.4)ng/L、(2.3±0.4)g/L,单纯组上述指标分别为58%±8%、32%±4%、27%±6%、1.26±0.22、16.26%±2.10%、(2.7±0.6)ng/L、(2.0±0.4)g/L。治疗前两组患者上述指标比较,差异均无统计学意义(t=-0.563,-0.354,-0.987,0.327,-0.462,0.887,0.991,P>0.05);治疗7 d后,两组患者CD3+、CD4+、CD4+/CD8+、NK细胞计数、血浆内毒素、IgA水平比较,差异均有统计学意义(t=-2.393,-4.336,-3.074,-5.338,4.010,-3.155,P<0.05);CD8+水平比较,差异无统计学意义(t=0.077,P>0.05)。生态免疫组患者CD4+、CD4+/CD8+、NK细胞计数、血浆内毒素、IgA水平治疗前与治疗7 d后比较,差异均有统计学意义(t=-2.899,-2.739,-4.385、2.157,-5.788,P<0.05);CD3+、CD8+水平治疗前与治疗7 d后比较,差异均无统计学意义(t=-0.490,1.193,P>0.05)。单纯组患者CD8+、IgA水平治疗前与治疗7 d后比较,差异均有统计学意义(t=3.659,-2.258,P<0.05);CD4+、CD4+/CD8+、NK细胞计数、血浆内毒素水平治疗前与治疗7 d后比较,差异均无统计学意义(t=0.157,0.759,1.132,1.212,-0.532,P>0.05)。(2)两组患者术后情况分析:生态免疫组患者术后首次肛门排气时间、术后住院时间分别为(2.4±0.5)d、(8±4)d,单纯组上述指标分别为(2.9±0.7)d、(11±7)d,两组患者上述指标比较,差异均有统计学意义(t=-3.017,-2.764,P<0.05)。生态免疫组患者并发症发生率为6.7%(2/30),其中切口感染1例、肺部感染1例;单纯组患者并发症发生率为31.3%(10/32),其中切口感染6例、肺部感染2例、腹腔感染1例、急性全身炎症反应综合征1例,两组患者并发症发生率比较,差异有统计学意义(χ2=4.122,P<0.05)。所有感染性并发症患者经相应对症保守治疗后均康复。(3)随访情况:62例患者中,46例患者获得术后随访,其中生态免疫组26例、单纯组20例;随访时间为3~9个月,中位随访时间为6个月。随访期间,两组患者均未发生并发症及再发感染。结论:与单纯肠内营养比较,术后早期肠内生态免疫营养在腹腔感染营养支持治疗中安全、有效,可以增强患者的免疫功能、缩短患者术后恢复时间、减少感染并发症的发生。

Objective:To explore the application value of early postoperative enteral eco-immune nutrition in the nutritional support treatment for intra-abdominal infection. Methods:The prospective study was conducted. The clinicopathological data of 62 patients with intra-abdominal infection who were admitted to the 940 Hospital of the People′s Liberation Army Joint Service Support Force from February 2018 to December 2018 were collected. All patients were randomly divided into two groups by the envelope method with double-blind technique, including patients who began being given enteral eco-immune nutrition preparation at postoperative 24-48 hours in eco-immune group and patients who began being given simple enteral nutrition preparation at 24-48 hours in control group. Observation indicators:(1) analysis of immune function indices before treatment and after 7 days of treatment in the two groups;(2) postoperative conditions in the two groups;(3) follow-up. Follow-up using telephone interview was performed to detect complications and recurrence of infection up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and intra-group comparison and comparison between groups were analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Results:Sixty-two patients were screened for eligibility, including 38 males and 24 females, aged (54±14)years, with the range of 22-81 years. There were 30 in the eco-immune group and 32 in the control group.(1) Analysis of immune function indices before treatment and after 7 days of treatment in the two groups: before treatment, the percentages of CD3+, CD4+, CD8+, ratio of CD4+/CD8+, count of natural killer (NK) cells, levels of blood endotoxin and immunoglobulin A (IgA) for the eco-immune group were 61%±12%, 34%±5%, 28%±5%, 1.25±0.34, 17.26%±2.74%,(2.4±0.3)ng/L, and (1.7±0.5)g/L, versus 59%±11%, 33%±5%, 27%±4%, 1.27±0.36, 16.96%±2.99%,(2.5±0.5)ng/L,(1.8±0.5)g/L for the control group, respectively, there were no significant differences between the two groups (t=-0.563,-0.354,-0.987, 0.327,-0.462, 0.887, 0.991, P>0.05). After 7 days of treatment, the above indices for the eco-immune group were 62%±8%, 37%±6%, 27%±8%, 1.45±0.32, 22.63%±7.25%,(2.2±0.4)ng/L, and (2.3±0.4)g/L, versus 58%±8%, 32%±4%, 27%±6%, 1.26±0.22, 16.26%±2.10%,(2.7±0.6)ng/L, and (2.0±0.4)g/L for the control group, respectively, there were significant differences in the percentages of CD3+, CD4+, ratio of CD4+/CD8+, count of NK cells, levels of blood endotoxin and IgA (t=-2.393,-4.336,-3.074,-5.338, 4.010,-3.155, P<0.05), but no significant difference in the percentage of CD8+ between the two groups (t=0.077, P>0.05). In the eco-immune group, the percentage of CD4+, ratio of CD4+/CD8+, count of NK cells, levels of blood endotoxin and IgA showed significant differences after 7 days of treatment (t=-2.899,-2.739,-4.385, 2.157,-5.788, P<0.05), but the percentages of CD3+ and CD8+ showed no significant differences after 7 days of treatment (t=-0.490, 1.193, P>0.05). In the control group, the percentage of CD8+ and level of IgA showed significant differences after 7 days of treatment (t=3.659,-2.258, P<0.05), but the percentage of CD4+, ratio of CD4+/CD8+, count of NK cells, and level of blood endotoxin showed no significant differences after 7 days of treatment (t=0.157, 0.759, 1.132, 1.212,-0.532, P>0.05).(2) Postoperative conditions in the two groups: the time to first flatus and duration of postoperative hospital stay of the eco-immune group were (2.4±0.5)days and (8±4)days, respectively, versus (2.9±0.7)days and (11±7)days of the control group;there were significant differences in the above indices between the two groups (t=-3.017,-2.764, P<0.05). In the eco-immune group, the incidence of complication was 6.7%(2/30), including 1 case of wound infection, 1 case of pulmonary infection. In the control group, the incidence of complication was 31.2%(10/32), including 6 cases of wound infection, 2 cases of pulmonary infection, 1 case of intra-abdominal infection, and 1 case of systemic inflammatory response syndrome. There was a significant difference in the incidence of complication between the two groups (χ2=4.122, P<0.05). The patients with infection were recovered after corresponding systematic conservative treatments.(3) Follow-up: of the 62 patients, 46 were followed up for 3-9 months, with a median follow-up time of 6 months, including 26 in the eco-immune group and 20 in the control group. During the follow-up, no complication or infection recurred in the two groups. Conclusion:Compared with simple enteral nutrition, early postoperative enteral eco-immune nutrition in the nutritional support treatment is safe and effective for patients with intra-abdominal infection, which can enhance the immune function of patients, shorten the recovery time of patients, and reduce the incidence of infection complications.