早期与延迟肠内营养对创伤性肠破裂患者术后肠黏膜屏障功能及免疫功能的影响

Effects of early enteral nutrition and delayed enteral nutrition on postoperative immune function and function of intestinal mucosal barrier in patients with traumatic intestinal rupture

目的分析早期与延迟肠内营养对创伤性肠破裂(TIR)患者术后肠黏膜屏障功能及免疫功能的影响。方法2015年1月—2019年3月陆军军医大学第二附属医院胃肠外科收治的经影像学确诊并行肠修补术的TIR患者38例,男性23例,女性15例;年龄35~71岁,平均58.73岁。致伤机制:道路交通伤22例,坠落伤12例,暴力击打伤3例,刀刺伤1例。依据术后营养方式分为早期肠内营养(EEN)组(n=20)与延迟肠内营养(DEN)组(n=18),EEN组术后48h给予肠内营养,DEN组术后5d给予肠内营养。观察两组术后1d、术后7d血清转铁蛋白(TF)、前清蛋白(PA)、白蛋白(ALB)等营养指标,D-乳酸(D-LA)、降钙素原(PCT)等肠黏膜屏障功能指标,CD3+、CD4+、CD8+、CD4+/CD8+细胞等免疫指标。结果术后7d,EEN组TF、PA、ALB及CD3+、CD4+、CD8+、CD4+/CD8+均大于DEN组(P<0.05)。术后7d,EEN组D-LA、PCT均小于DEN组(P<0.05)。结论EEN可为TIR手术患者提供充足营养,改善术后肠黏膜屏障功能,提高机体免疫能力,促进患者康复,且安全可靠。

Objective To analyze the effect of early enteral nutrition(EEN)and delayed enteral nutrition(DEN)on intestinal mucosal barrier function and immune function in patients with traumatic intestinal rupture(TIR).Methods A total of 38 patients with TIR diagnosed by imaging,who were admitted into our hospital from Jan.2015 to Mar.2019 were included in this study,including 23 males and 15 females aged from 35 to 71 years,with an average age of 58.73 years.Injury factors included 22 cases of traffic accidents,12 cases of falling injury,3 cases of violent beating,and 1 case of stabbing.They were divided into EEN group(n=20)and DEN group(n=18)using alimentation mode after the operation.Enteral nutrition was given 48h after surgery in EEN group and 5d after surgery in DEN group.The levels of nutritional factors at postoperative days 1 and 7 such as serum Transferrin(TF),Prealbumin(PA),Albumin(ALB);the levels of function of intestinal mucosaI barrier factors such as serum D-lactic acid(D-LA)and Procalcitonin(PCT);the levels of cell-mediated immunity factors such as serum CD3+,CD4+,CD8+,CD4+/CD8+were observed.Results At 7 days after operation,TF,PA,ALB,BMI,CD3+,CD4+,CD8+,CD4+/CD8+in EEN group were higher than those in DEN group(P<0.05).At 7 days after operation,D-LA,PCT in EEN group were lower than those in DEN group(P<0.05).Conclusion EEN can provide adequate nutrition for TIR patients,improve the postoperative function of intestinal mucosal barrier,improve the immune ability,promote the recovery of patients,and it is safe.