早期肠内营养在重症肺炎并胃肠功能障碍患者中的应用

Application of early enteral nutrition in patients with severe pneumonia and gastrointestinal dysfunction

目的观察早期肠内营养在重症肺炎并胃肠功能障碍患者中的应用效果。方法选取2019年3月至2021年3月广州市番禺区妇幼保健院收治的62例重症肺炎并胃肠功能障碍患者为研究对象,按照随机数表法将患者分为研究组与对照组各31例。对照组患者于入科后72 h提供肠内营养,研究组患者于入科后24~48 h提供肠内营养。1周后,比较两组患者的临床疗效,治疗前后的营养指标[前白蛋白(PAB)、白蛋白(ALB)、血红蛋白(HGB)]、感染指标[C反应蛋白(CRP)、降钙素原(PCT)]及肠黏膜屏障指标[二胺氧化酶(DAO)、D-乳酸]水平。结果研究组患者的治疗总有效率为93.55%,明显高于对照组的74.19%,差异有统计学意义(P<0.05);治疗后两组患者的PAB、ALB、HGB水平明显高于治疗前,且研究组患者治疗后的PAB、ALB、HGB水平分别为(216.32±8.03) g/L、(39.79±2.61) g/L、(106.64±4.31) g/L,明显高于对照组的(188.96±8.23) g/L、(35.66±3.08) g/L、(99.94±4.62) g/L,差异均有统计学意义(P<0.05);治疗后两组患者的CRP、PCT、DAO、D-乳酸水平明显低于治疗前,且研究组患者治疗后的CRP、PCT、DAO、D-乳酸水平分别为(70.57±8.23) mg/L、(2.69±0.74) ng/L、(8.96±1.38)μg/L、(7.08±1.65)μg/L,明显低于对照组的(83.09±9.68) mg/L、(3.40±1.02) ng/L、(9.99±1.21)μg/L、(8.91±2.13)μg/L,差异均有统计学意义(P<0.05)。结论入科后24~48 h提供肠内营养可以提高重症肺炎并胃肠功能障碍患者的疗效,保护肠屏障功能,同时还能减轻炎症反应,值得推广应用。

Objective To observe the effect of early enteral nutrition in patients with severe pneumonia and gastrointestinal dysfunction. Methods Sixty-two patients with severe pneumonia and gastrointestinal dysfunction treated in Guangzhou Panyu Maternal and Child Health Hospital from March 2019 to March 2021 were selected as the research objects. According to random number table, they were divided into a study group and a control group, with 31 patients in each group. Patients in the control group received enteral nutrition 72 hours after the procedure, and those in the study group received enteral nutrition 24 to 48 hours after the procedure. After 1 week, the clinical efficacy, the nutritional indicators before and after treatment [pre-albumin(PAB), albumin(ALB), hemoglobin(HGB)], infection indicators[C-reactive protein(CRP), procalcitonin(PCT)], and the intestinal mucosal barrier index [diamine oxidase(DAO), D-lactic acid] levels were compared between the two groups. Results The total effective rate of treatment in the study group was 93.55%, which was significantly higher than 74.19% in the control group(P<0.05);after treatment, the levels of PAB, ALB, and HGB in the two groups were significantly higher than those before treatment;the levels of PAB, ALB,and HGB in the study group after treatment were(216.32±8.03) g/L,(39.79±2.61) g/L,(106.64±4.31) g/L, significantly higher than(188.96±8.23) g/L,(35.66±3.08) g/L,(99.94±4.62) g/L in the control group(P<0.05). After treatment, the levels of CRP, PCT, DAO, and D-lactic acid in the two groups were significantly lower than those before treatment;the levels of CRP, PCT, DAO, and D-lactic acid in the study group after treatment were(70.57±8.23) mg/L,(2.69±0.74) ng/L,(8.96±1.38) μg/L,(7.08±1.65) μg/L, significantly lower than(83.09±9.68) mg/L,(3.40±1.02) ng/L,(9.99±1.21) μg/L,(8.91±2.13) μg/L in the control group(P<0.05). Conclusion Enteral nutrition 24 to 48 hours after admission can improve the curative effect of patients with severe pneumonia and gastrointestinal dysfunction, protect the intestinal barrier function,and reduce inflammation, which is worthy of popularization and application.