高能肠内营养对肺源性心脏病心力衰竭患者营养状态和免疫功能的影响

Effects of high energy enteral nutrition on nutritional status and immune function in patients with pulmonary heart failure

目的探讨高能肠内营养(EN)对肺源性心脏病(肺心病)所致心力衰竭(心衰)患者营养状态和免疫功能的影响.方法选择2017年3月至2018年3月台州市第一人民医院重症医学科收治的肺心病所致心衰患者86例,将患者按使用EN制剂的不同分为高能EN组和标准EN组,每组43例.高能EN组给予高能EN液瑞能治疗;标准EN组给予标准EN液瑞素治疗;所有患者EN初始速度均为25 mL/h,目标热量3 d内达到104.6~125.5 kJ·kg^-1·d^-1,蛋白为1.5~2 g·kg^-1·d^-1,血糖控制在7.8~11.1 mmol/L.比较两组热量和蛋白达标率、营养状态、炎症反应以及免疫功能的差异.结果从EN 3 d起,高能EN组热量及蛋白达标率均高于标准EN组〔热量达标率:69.77%(30/43)比41.86%(18/43),蛋白达标率:25.58%(11/43)比11.63% (5/43)〕,持续到EN 7 d.随EN时间的延长,两组白蛋白(Alb)、转铁蛋白(TRF)、前白蛋白(PA)、人白细胞DR抗原(HLA-DR)阳性率以及免疫球蛋白(IgA、IgG)均持续升高,EN 7 d时达峰值,且高能EN组明显高于标准EN组〔Alb(g/L):36.43±5.81比33.79±5.34,TRF(mg/L):3.58±0.64比3.26±0.81,PA(mg/L):278.83± 47.56比251.67±41.92,HLA-DR阳性率:(53.22±6.11)%比(50.21±5.69)%,IgG(mg/L):4 990.68±881.66比4 211.75±861.54,IgA(mg/L):165.34±40.13比141.54±38.76,均P<0.05〕;而两组C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平则逐渐降低,EN 7 d时达谷值,且高能EN组明显低于标准EN组〔TNF-α(ng/L):14.43±8.69比20.59±9.45,CRP(mg/L):21.33±6.35比27.36±7.83,均P<0.05〕.结论高能EN不仅能改善肺心病心衰患者的营养状态,还能减轻炎症反应水平,提高患者免疫功能.

Objective To investigate the effects of high energy enteral nutrition(EN)on nutritional status and immune function in patients with heart failure caused by pulmonary cardiac disease.Methods Eighty-six patients with heart failure caused by pulmonary heart disease were continuously collected from March 2017 to March 2018 in the Department of Critical Care Medicine of Taizhou First People's Hospital,and they were divided into a high-energy EN group and a standard EN group according to the different use of EN preparations,each group with 43 cases.The high-energy EN group were treated with high energy EN solution TPF-T(Ruineng),and the standard EN group were treated with standard EN solution TP(Ruisu);the initial EN infusion velocity in all the patients was 25 mL/h,the calorific calorie would reach the target to 104.6-125.5 kJ·kg-1·d-1,and the protein would target to 1.5-2 g·kg-1·d-1 within 3 days;the blood glucose was controlled within the scope of 7.8-11.1 mmol/L.The differences in rates of calorie and protein goal targeting situations,nutritional status,inflammatory response and immune function were compared between the two groups.Results From the 3rd day to 7th day after EN application,the rates of calorie and protein goal targeted in the high-energy EN group were significantly higher than those in the standard EN group[calorie targeted rate:69.77%(30/43)vs.41.86%(18/43),protein targeted rate:25.58%(11/43)vs.11.63%(5/43),all P<0.05].With the extension of EN application,nutritional indexes such as albumin(Alb),prealbumin(PA),transferrin(TRF),etc.and the immune indexes such as human leucocyte antigen(HLA)-DR positive rate,immunoglobulins(IgA,IgG),etc.were persistently increased in both groups,reaching the peak values on the 7th day,and the indexes in high-energy EN group were significantly higher than those in the standard EN group[Alb(g/L):36.43±5.81 vs.33.79±5.34,PA(mg/L):278.83±47.56 vs.251.67±41.92,TRF(mg/L):3.58±0.64 vs.3.26±0.81,HLA-RD positive rate:(53.22±6.11)%vs.(50.21±5.69)%,IgA(mg/L):165.34±40.13 vs.141.54±38.76,IgG(mg/L):4990.68±881.66 vs.4211.75±861.54,all P<0.05].However,the levels of inflammatory factors such as C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)in both groups were gradually decreased,reaching the valley values on the 7th day,and the indexes in high-energy EN group were significantly lower than those in the standard EN group[TNF-α(ng/L):14.43±8.69 vs.20.59±9.45,CRP(mg/L):21.33±6.35 vs.27.36±7.83,all P<0.05].Conclusion High energy EN not only can improve the nutritional status in patients with pulmonary heart failure,but also can reduce patients’inflammation response and elevate their immune function.