高能量密度肠内营养乳剂对重症肺部感染患者免疫功能的影响

Effect of high-energy-density enteral nutrition emulsions on immune function in patients with severe lung infections

目的探讨高能量密度肠内营养(enteral nutrition,EN)乳剂对重症肺部感染患者免疫功能的影响。方法收集2017年10月-2021年8月安徽省第二人民医院重症医学科收治的89例重症肺部感染患者作为研究对象,以数字表法分为对照组(n=44)和研究组(n=45),对照组采用常规EN制剂(能量密度1.0 kcal/mL)鼻饲治疗,研究组采用高能量密度EN乳剂(能量密度1.5 kcal/mL)鼻饲治疗,对比两组治疗前后的营养指标、免疫功能指标、相关临床指标以及并发症发生率。结果治疗前两组的营养基线和健康状况比较,差异无统计学意义(P>0.05),提示可比性良好;治疗后研究组细胞免疫功能指标CD3^(+)、CD4^(+)、CD8^(+)T细胞和CD4^(+)T细胞/CD8^(+)T细胞比值和体液免疫指标免疫球蛋白(immunoglobulin,Ig)A、IgM和IgG水平均高于对照组(P<0.05);研究组住院时间、ICU入住时间和并发症发生率均显著低于对照组(P<0.05);两组住院期间的病死率比较,差异无统计学意义(P>0.05)。结论重症肺部感染患者接受高能量密度EN乳剂治疗不仅可以改善患者的营养状态和免疫功能,还可缩短病程,减少并发症,安全性高,因此,该疗法值得在临床上推广应用。

Objective To investigate the effect of high-energy-density enteral nutrition(EN) emulsion on immune function in patients with severe lung infection. Methods From October 2017 to August 2021, 89 patients with severe lung infection admitted to our hospital were selected as the research objects, and they were randomly divided into control group(n=44) and the research group(n=45) by numerical table method. The control group was treated with conventional EN preparations(energy density 1.0 kcal/mL) by nasal feeding, and the research group was treated with high energy density EN emulsion(energy density 1.5 kcal/mL) by nasal feeding, and the nutritional indexes, immune function indicators, clinical indicators and complication rates before and after treatment between the two groups were compared. Results There was no statistically significant difference in nutritional baseline and health status between the two groups(P>0.05), which indicated a good comparability. The cellular immune function indicators CD3^(+), CD4^(+), CD8^(+)T cells and the ratio of CD4^(+)T cells/CD8^(+)T cells, and humoral immune indicators immunoglobulin(Ig) A, IgM and IgG levels in the control group were significantly lower than those in the control group(P value<0.05), and the length of stay, intensive care unit(ICU) admission time and complication rate of the study group were significantly lower than those in the control group(P value<0.05);there was no statistically significant difference in mortality during hospitalization between the two groups(P value>0.05). Conclusion Patients with severe lung infection receiving high energy density EN emulsion therapy can not only improve the nutritional status and immune function of patients, but also shorten the course of the disease, reduce complications, and have a high safety, thus this therapy is worth promoting and applying in the clinic.