不同肠内营养时机对重症心衰呼吸支持患者血清BNP、营养状态、T细胞亚群的影响及安全性探讨

The effect of different enteral nutrition timing on serum BNP,nutri-tional status,T cell subsets and safety in patients with severe heart fail-ure and respiratory support

目的探讨不同肠内营养时机对重症心衰呼吸支持患者血清B型脑钠肽(BNP)、营养状态、T细胞亚群的影响及安全性。方法选取2017年7月—2020年6月陆军第73集团军医院重症心衰呼吸支持患者148例,依据干预方案分为早期肠内营养(EEN)组与延迟肠内营养(DEN)组,各74例。统计两组治疗情况,干预前及干预3 d、7 d后营养状态指标[转铁蛋白(TF)、前白蛋白(PA)、白蛋白(ALB)]水平、炎性因子[白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、肿瘤坏死因子-α(TNF-α)]水平、心功能指标[BNP、左心室射血分数(LVEF)]水平、T细胞亚群指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平、不良事件发生情况。结果EEN组达EN目标用时短于DEN组(P<0.05);干预3 d、7 d后两组TF、PA、ALB、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较干预前增高(P<0.05),且EEN组高于DEN组(P<0.05);干预3 d、7 d后两组血清IL-6、hs-CRP、WBC、TNF-α、BNP水平较干预前降低(P<0.05),且EEN组低于DEN组(P<0.05);EEN组不良事件发生率(8.33%)与DEN组(5.71%)比较无显著差异(P>0.05)。结论采取早期肠内营养对重症心衰呼吸支持患者实施干预效果优于延迟肠内营养,利于及早改善营养状态及免疫功能,下调体内炎性因子含量及BNP水平,且安全性有保证。

Objective To investigate the effects and safety of different enteral nutrition timing on serum B-type brain natriuretic peptide(BNP),nutritional status,T cell subsets in patients with severe heart failure and respiratory support.Methods A total of 148 patients with severe heart failure and respiratory support in our hospital from July 2017 to June 2020 were selected.According to the intervention plan,they were divided into early enteral nutrition(EEN)group and delayed enteral nutrition(DEN)group,with 74 cases in each group.The treatment status,nutrition⁃al status indicators[transferrin(TF),prealbumin(PA),albumin(ALB)]levels,inflammatory factors[interleukin-6(IL-6),high sensitivity C-reactive protein(hs-CRP),white blood cell count(WBC),tumor necrosis factor-α(TNFα)]levels,cardiac function index[BNP,left ventricular ejection fraction(LVEF)]level,T cell subgroup indicators(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))levels before intervention and 3 and 7 days after intervention,and the occurrence of ad⁃verse events in the two groups were counted.Results The time to reach the EN target in the EEN group was shorter than that in the DEN group(P<0.05);the levels of TF,PA,ALB,CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the two groups were higher than before the intervention(P<0.05)after the intervention for 3 and 7 days,and the EEN group was higher than the DEN group(P<0.05);serum levels of IL-6,hs-CRP,WBC,TNF-α,and BNP in the two groups were lower than before the intervention(P<0.05)after the intervention for 3 and 7 days,and the EEN group was lower than the DEN group(P<0.05);there was no significant difference between the incidence of adverse events in the EEN group(8.33%)and the DEN group(5.71%)(P>0.05).Conclusion Early enteral nutrition is better than delayed enteral nu⁃trition for patients with severe heart failure with respiratory support.It is beneficial to improve the nutritional status and immune function as soon as possible.It can reduce the content of inflammatory factors and BNP levels in the body,and the safety is guaranteed.