早期肠内营养制剂联合谷氨酰胺、低分子肝素对老年重症肺炎患者炎症程度、T淋巴细胞亚群分布及并发症发生率的影响

Effect of Early Enteral Nutrition Combined with Glutamine and Low Molecular Weight Heparin on Inflammatory Degree,Distribution of T Lymphocyte Subsets and Incidence of Complications in Elderly Patients with Severe Pneumonia

目的:探讨早期肠内营养制剂联合谷氨酰胺、低分子肝素对老年重症肺炎患者炎症程度、T淋巴细胞亚群分布及并发症发生率的影响。方法:选取2017年2月-2019年2月本院收治的老年重症肺炎患者90例作为研究对象,经随机数表法分为对照组、研究组各45例。对照组患者在常规治疗同时接受早期肠内营养制剂,研究组患者在对照组基础上加入谷氨酰胺、低分子肝素,持续1周后评估疗效。对比两组患者的治疗效果、血清炎症介质[高迁移率族蛋白(HMGB-1)、白介素-17(IL-17)、单核细胞趋化蛋白1(MCP-1)、C反应蛋白(CRP)、降钙素原(PCT)]及外周血T淋巴细胞亚群[CD3^+、CD4^+、CD8^+T淋巴细胞、CD4^+/CD8^+比值]分布水平的差异,记录治疗期间药物相关不良反应、严重并发症的发生情况。结果:治疗1周后,研究组患者的总有效率高于对照组患者(P<0.05);血清中HMGB-1、IL-17、MCP-1、CRP、PCT的水平低于对照组患者;外周血中CD3^+、CD4^+T淋巴细胞分布水平及CD4^+/CD8^+比值大于对照组,CD8^+T淋巴细胞分布水平低于对照组(P<0.05)。治疗期间,两组恶心呕吐、头晕头痛、腹泻便秘、皮疹水泡发生率的差异无统计学意义(P>0.05);研究组患者的弥散内血管内凝血、脓毒症发生率低于对照组患者(P<0.05);两组间心力衰竭、死亡率差异无统计学意义(P>0.05)。结论:老年重症肺炎患者在早期肠内营养制剂应用同时采用谷氨酰胺、低分子肝素进行联合干预,可积极提升疗效并均衡机体炎症反应、免疫紊乱,一定程度减少严重并发症发生。

Objective To investigate the effects of early enteral nutrition combined with glutamine and low molecular weight heparin on the degree of inflammation,distribution of T lymphocyte subsets and incidence of complications in elderly severe pneumonia patients.Method Totally 90 cases of elderly severe pneumonia patients admitted to our hospital during February 2017 to February 2019 were selected as research subjects.They were randomly divided into control group and study group each with 45 cases.Patients in control group were treated with early enteral nutrition preparations based on routine treatment,those in study group were added glutamine and low molecular weight heparin based on control group,the curative effect was evaluated after 1 week.The therapeutic effect,distribution of serum inflammatory mediators[high mobility group protein(HMGB-1),interleukin-17(IL-17),monocyte chemoattractant protein-1(MCP-1),C-reactive protein(CRP),procalcitonin(PCT)]and peripheral blood T lymphocyte subsets[CD3^+,CD4^+,CD8^+T lymphocyte,CD4……+/CD8+ratio)]were compared between two groups,and adverse drug-related reactions and the occurrence of severe complications during treatment were recorded.Result After one week of treatment,total effective rate of study group was higher than that of control group(P<0.05),levels of HMGB-1,IL-17,MCP-1,CRP and PCT in serum of study group were lower than those of control group,levels of CD3^+,CD4^+T lymphocyte distribution and CD4^+/CD8^+ratio in peripheral blood were higher than those of control group,level of CD8+T lymphocyte distribution was lower than those of control group(P<0.05).There were no significant difference in the incidence of nausea,vomiting,dizziness,headache,diarrhea,constipation and rash blisters between two groups during treatment(P>0.05),incidence of disseminated intravascular coagulation and sepsis in study group were lower than those in control group(P<0.05).There were no significant difference in heart failure and mortality between two groups(P>0.05).Conclusion The combined intervention of glutamine and low molecular weight heparin in the early enteral nutrition preparation for elderly patients with severe pneumonia can actively improve the curative effect,balance the inflammatory reaction and immune disorder,and reduce the occurrence of serious complications to a certain extent.