不同方式高蛋白营养支持对危重症患者的影响

Effects of different types of high-protein nutritional support on critically ill patients

目的探讨不同方式高蛋白营养支持对危重症患者营养状态、免疫功能及治疗结局的影响。方法选取我院危重症患者90例,随机分为对照组、蛋白粉组与氨基酸组,各30例。3组在给予相等非蛋白质热量[25 kcal·kg^(-1)·d^(-1)]摄取条件下,对照组仅给予肠内营养乳剂TPF(瑞先),蛋白粉组按照1.5~2.0 g·kg^(-1)·d^(-1)给予乳清蛋白粉,氨基酸组按照1.5~2.0 g·kg^(-1)·d^(-1)给予复方氨基酸,3组均干预2周。统计3组治疗情况(住ICU时间、机械通气时间)、不良事件发生率、干预前及干预1周、2周后营养相关指标、T淋巴细胞亚群。结果蛋白粉组、氨基酸组住ICU时间、机械通气时间短于对照组;蛋白粉组、氨基酸组干预1周、2周后营养状态及免疫功能均高于对照组(P<0.05);3组不良反应发生率差异无统计学意义(P>0.05)。结论通过高蛋白营养支持,有助于增强机体免疫功能,纠正营养不良,改善治疗结局。

Objective To investigate the effects of different types of high-protein nutritional support on nutritional status,immune function and treatment outcome of critically ill patients.Methods A total of 90 critically ill patients treated in our hospital were randomly divided into control group,protein powder group and amino acid group,with 30 cases in each group.The three groups were given equal non-protein calories[25 kcal·kg^(-1)·d^(-1)].On this basis,the control group was only given enteral nutrition emulsion TPF,the protein powder group was given whey protein powder[1.5-2.0 g·kg^(-1)·d^(-1)],and amino acid group was given compound amino acid[1.5-2.0 g·kg^(-1)·d^(-1)].The three groups were intervened for 2 weeks.The treatment conditions(duration of ICU stay,duration of mechanical ventilation),incidence of adverse events,nutrition-related indicators and T lymphocyte subsets were recorded before intervention and at 1 and 2 weeks after intervention.Results The duration of ICU stay and duration of mechanical ventilation were shorter in protein powder group and amino acid group than in control group;nutritional status and immune function at 1 and 2 weeks after intervention were higher in protein powder group and amino acid group than in control group(P<0.05).There was no significant difference in the incidence of adverse reactions among three groups(P>0.05).Conclusion High-protein enteral nutrition support can improve the immune function,correct malnutrition,and improve the treatment outcome.