肠内营养标准化流程对感染性休克伴急性胃肠功能损伤的影响

Effect of standardized enteral nutrition process on septic shock with acute gastrointestinal dysfunction

目的 探讨肠内营养标准化流程管理应用于感染性休克伴急性胃肠功能损伤患者的临床效果。方法 选取2018年1月至2020年7月上海交通大学医学院附属瑞金医院舟山分院收治的103例感染性休克伴急性胃肠功能损伤患者纳入观察组,将2016年5月至2017年12月就诊的80例患者纳入对照组。在常规治疗的基础上,对照组患者实施常规肠内营养管理,观察组患者实施肠内营养标准化流程管理;干预2周后,比较两组患者的肠屏障功能、营养状况、免疫功能及预后转归情况。结果 干预后,观察组患者的D-乳酸、CD8^(+)显著低于对照组(P<0.05),血浆总蛋白、白蛋白、前白蛋白、CD4^(+)及CD4^(+)/CD8^(+)均显著高于对照组(P<0.05)。干预后,观察组患者的机械通气时间及入住重症监护病房时间均显著短于对照组(P<0.05),28d病死率显著低于对照组(P<0.05)。结论 肠内营养标准化流程管理的应用有助于改善感染性休克伴急性胃肠功能损伤患者的肠屏障功能及营养状况,促进患者的免疫功能恢复,缩短机械通气时间及入住重症监护病房时间,降低病死率,对改善患者预后具有积极意义。

Objective To investigate the clinical effect of enteral nutrition standardized process management in patients with septic shock and acute gastrointestinal function injury.Methods One hundred and three cases of septic shock with acute gastrointestinal function injury in Zhoushan Branch,Ruijin Hospital,Shanghai Jiaotong University School of Medicine were enrolled in observation group from January 2018 to July 2020,and 80 cases of patients were enrolled in control group from May 2016 to December 2017.On the basis of routine treatment,control group received routine enteral nutrition management,and observation group received standardized enteral nutrition process management.After 2 weeks of intervention,intestinal barrier function,nutritional status,immune function,and prognosis were compared between the two groups.Results After the intervention,the D-lactate level and CD8^(+)in observation group was lower than that in control group(P<0.05),and the plasma total protein,albumin,prealbumin CD4^(+)and CD4^(+)/CD8^(+)were higher than those in control group(P<0.05).After the intervention,the mechanical ventilation time and intensive care unit stay time of observation group were significantly shorter than those of control group(P<0.05),and the 28-day mortality was significantly lower than that of control group(P<0.05).Conclusion The application of standardized enteral nutrition management can improve the intestinal barrier function and nutritional status of patients with septic shock and acute gastrointestinal function injury,promote the recovery of immune function,shorten the time of mechanical ventilation and stay in intensive care unit,reduce the case fatality rate,and have positive significance for improving the prognosis of patients.