免疫增强型肠内营养治疗脓毒性休克合并急性胃肠损伤的临床疗效

Clinical effect of immune-enhancing enteral nutrition on septic shock complicated with acute gastrointestinal injury

目的 探讨免疫增强型肠内营养治疗脓毒性休克合并急性胃肠损伤(AGI)的临床疗效。方法 选择南通市妇幼保健院重症医学科2019年12月-2020年12月脓毒性休克患者64例为研究对象,随机分为研究组和对照组各32例。研究组使用免疫增强型肠内营养制剂给予肠内营养,对照组使用普通型肠内营养制剂给予肠内营养。比较两组治疗7 d后AGI改善情况、统计重症监护室(ICU)住院时间、抗感染治疗时间和机械通气时间。抽取外周血并分离血清,检测治疗前后肠屏障功能指标[D-乳酸和内毒素(ET)]以及核苷酸结合寡聚化结构域样受体3(NLRP3)通路因子[NLRP3、Casepase-1和白细胞介素-1B(IL-1B)]水平。结果 研究组AGI总有效率高于对照组(P<0.05);研究组患者ICU住院时间、抗感染治疗时间和机械通气时间短于对照组(P<0.05),但两组28 d死亡例数比较,无统计学差异;治疗前两组血清中D-乳酸、ET、NLRP3、Casepase-1和IL-1B水平比较,无统计学差异;治疗后两组血清中D-乳酸、ET、NLRP3、Casepase-1和IL-1B水平均较治疗前降低(P<0.05);治疗后研究组血清中D-乳酸、ET、NLRP3、Casepase-1和IL-1B水平低于对照组(P<0.05)。结论 免疫增强型肠内营养可显著改善脓毒性休克的AGI状态,在一定程度上恢复肠黏膜屏障功能,并降低NLRP3/Casepase-1/IL-1B介导的过度炎症损伤。

OBJECTIVE To explore the clinical effect of immune-enhancing enteral nutrition on septic shock complicated with acute gastrointestinal injury(AGL). METHODS A total of 64 patients with septic shock who were treated in critical medicine department of Nantong Maternity and Child Health Hospital from Dec 2019 to Dec 2020 were recruited as the study objects and randomly divided into the study group and the control group,with 32 cases in each group. The study group was given immune-enhancing enteral nutrition preparations for enteral nutrition,and the control group was given common enteral nutrition preparations for enteral nutrition. The improvement status of AGI was compared between the two groups after the treatment for 7 days,the length of hospital stay in intensive care unit(ICU),time of anti-infection treatment and mechanical ventilation duration were statistically analyzed. The peripheral blood specimens were drawn to separate serum,and the levels of intestinal barrier function indexes [D-lactate and endotoxin(ET)] and nucleotide-binding oligomerization domain-like receptor 3(NLRP3) pathway factors [NLRP3,Casepase-1 and interleukin-1 B(IL-1 B))] were detected before and after the treatment. RESULTS The total effective rate of AGI of the study group was significantly higher than that of the control group(P<0.05). The length of ICU stay,time of anti-infection treatment and mechanical ventilation duration were significantly shorter in the study group than in the control group(P<0.05),there was no significant difference in the number of cases died within 28 days between the two groups. There were no significant differences in the levels of serum D-lactate,ET,NLRP3,Casepase-1 and IL-1 B between the two groups before the treatment;the levels of serum D-lactate,ET,NLRP3,Casepase-1 and IL-1 B of the two groups were significantly lower after the treatment than before the treatment(P<0.05). The levels of serum D-lactate,ET,NLRP3,Casepase-1 and IL-1 B of the study group were significantly lower than those of the control group after the treatment(P<0.05). CONCLUSION The immune-enhancing enteral nutrition can remarkably improve the AGI status of septic shock,restore the intestinal mucosal barrier function to a certain extent and reduce the NLRP3/Casepase-1/IL-1 B-mediated excessive inflammatory damage.