乳清蛋白粉强化肠内营养对重症结核病患者营养状况和临床结局的影响

The effect of whey protein powder on nutritional status and clinical outcome of patients with severe tuberculosis

目的探讨乳清蛋白粉强化肠内营养对重症结核病患者营养状况和临床结局的影响。方法选取2018年1月至2019年12月于本院结核ICU住院的120例重症结核患者作为研究对象,随机分为对照组与实验组,每组60例。对照组给予肠内营养乳剂TPF,实验组给予肠内营养乳剂TPF+乳清蛋白粉。比较两组治疗前和治疗10 d后血清白蛋白水平、淋巴细胞计数、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及入住ICU时间、感染发生率、胃肠道不良反应发生率。结果治疗前,两组血清白蛋白水平和淋巴细胞计数比较差异无统计学意义;治疗10 d后,两组血清白蛋白水平和淋巴细胞计数均高于治疗前,且实验组高于对照组,差异有统计学意义(P<0.05);实验组APACHEⅡ评分低于对照组,入住ICU时间短于对照组,差异有统计学意义(P<0.05)。两组消化道不良反应比较差异无统计学意义;实验组继发感染发生率低于对照组,差异有统计学意义(P<0.05)。结论乳清蛋白粉强化的肠内营养治疗可改善重症结核病患者营养和免疫状况,缩短入住ICU时间,改善预后,减少感染并发症发生,不增加胃肠道不良反应。

Objective To investigate the effect of whey protein powder on nutritional status and clinical outcome of patients with severe tuberculosis.Methods 120 severe tuberculosis patients hospitalized in the tuberculosis ICU of our hospital from January 2018 to December 2019 were selected as the research subjects,and they were randomly divided into control group and experimental group,with 60 cases in each group.The control group was given enteral nutrition emulsion TPF,and the experimental group was given enteral nutrition emulsion TPF+whey protein powder.The serum albumin level,lymphocyte count,and acute physiology and chronic health evaluation scoring system(APACHEⅡ)score before and 10 d after treatment and the ICU stay time,incidence of infection,and incidence of gastrointestinal adverse reactions were compared between the two groups.Results Before treatment,there was no statistically significant difference in serum albumin level and lymphocyte count between the two groups;after 10 d of treatment,the serum albumin level and lymphocyte count of two groups were higher than before treatment,and the experimental group was higher than the control group,the differences were statistically significant(P<0.05).The APACHEⅡscore in the experimental group was lower than that in the control group,and ICU stay time was shorter than that in the control group,the differences were statistically significant(P<0.05).There was no statistically significant difference in the adverse reactions of the digestive tract between the two groups;the secondary incidence rate in the experimental group was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion The enteral nutrition treatment strengthened with whey protein powder can improve the nutritional and immune status of patients with severe tuberculosis,shorten the ICU stay time,improve prognosis,reduce the incidence of infection complications,and have no increase in gastrointestinal adverse reactions.