个体化营养支持在成人Stanford A型主动脉夹层中的应用

Application of individualized nutrition support for adults with Stanford A aortic dissection

目的:主动脉夹层是一种严重的主动脉病变,尽管外科手术的水平不断提高,但术后病死率及手术并发症发生率仍然较高。本研究旨在探讨个体化营养支持在成人Stanford A型主动脉夹层中的应用效果。方法:选取2019年1月至2020年2月中国科学技术大学附属第一医院心脏大血管外科收治的60例Stanford A型主动脉夹层患者为研究对象。采用随机数字表法将患者分为对照组(n=29)和观察组(n=31),对照组术后第1天开始进行常规营养支持治疗,观察组术后第1天开始进行个体化营养支持。术后第1天、第5天、第10天采用罗氏生化分析仪、免疫分析仪和酶标仪分别检测两组血清营养指标[白蛋白(albumin,Alb)、前白蛋白(prealbumin,PAB)、血红蛋白(hemoglobin,Hb)、转铁蛋白(transferrin,TF)]、免疫功能指标[免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白M(immunoglobulin M,IgM)、免疫球蛋白A(immunoglobulin A,IgA)]和炎症因子[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-10(interleukin-10,IL-10)、降钙素原(procalcitonin,PCT)]水平变化,术后第1天、第5天、第10天采用急性生理与慢性健康评分II(Acute Physiology and Chronic Health Evaluation II,APACHEII)评估两组预后,并观察两组并发症发生率。结果:两组Alb、PAB、Hb、TF、IgG、IgM、IgA、TNF-α、IL-10、PCT、APACHEII评分主体效应检验、时间因素及组间因素检验差异均有统计学意义(均P<0.01),术后第5天、第10天观察组Alb、PAB、Hb、TF、IgG、IgM、IgA均明显高于对照组(均P<0.01);术后第5天、第10天观察组TNF-α、IL-10、PCT、APACHEII评分均低于对照组(均P<0.01)。观察组并发症发生率低于对照组(P<0.05)。结论:对于接受手术的Stanford A型主动脉夹层患者而言,术后积极进行个体化营养支持治疗不仅可明显提高患者营养水平和免疫功能,且可有效降低术后炎症因子水平,有利于机体快速康复,对降低术后并发症的发生率和改善预后亦有积极的临床意义。

Objective:Aortic dissection is a serious aortic pathological changes.Although the surgical technique for aortic dissection continues to improve,postoperative mortality and surgical complications are still high.This study aims to explore the effect of individualized nutritional support for the adult Stanford A aortic dissection.Methods:A total of 60 patients with Stanford A aortic dissection,who were treated in the Department of Cardiovascular Surgery at the First Affiliated Hospital of University of Science and Technology of China from January 2019 to February 2020,were selected.The subjects were divided into a control group(n=29)and an observation group(n=31)by random number table method.The control group received routine nutritional support,and the observation group received individualized nutritional support since the 1 st day after surgery.The levels of serum nutritional indexes[albumin(Alb),prealbumin(PAB),hemoglobin(Hb),transferrin(TF)],immune function indexes[immunoglobulin G(Ig G),immunoglobulin M(Ig M),immunoglobulin A(Ig A)],and inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),procalcitonin(PCT)]on the first day,the5 th day,and the 10 th day after surgery were detected by Roche biochemical analyzer,immunoassay analyzer,and microplate reader,respectively.The acute physiology and chronic health evaluation II(APACHEII)was used to evaluate the prognosis on the first day,the 5 th day,and the 10 th day after surgery,and the incidence of complications was observed in the 2 groups.Results:There were significant differences between the 2 groups in Alb,PAB,Hb,TF,Ig G,Ig M,Ig A,TNF-α,IL-10,and PCT(all P<0.01),and there were also significant differences in the APACHEII,the time factor and the group factor(all P<0.01).On the 5 th day and the 10 th day after surgery,the levels of Alb,PAB,Hb,TF,Ig G,Ig M and Ig A were higher,and the levels of TNF-αand IL-10 while the scores of PCT and APACHEII were lower in the observation group than those in the control group(all P<0.01).The incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:For patients with Stanford A aortic dissection undergoing surgery,the postoperative individualized nutrition support can not only significantly improve nutritional level and immune function,but also effectively reduce levels of postoperative inflammatory factors,which is beneficial to their rapid recovery and has positive clinical significance for reducing postoperative complications and improving prognosis.