早期高脂肠内营养支持对脓毒症患者肠屏障功能和迷走神经活性的影响

Effects of early high-fat enteral nutrition support on intestinal barrieRfunction and vagal nerve activity in patients with sepsis

目的观察早期高脂肠内营养支持是否进一步改善常规治疗的脓毒症患者的预后,并探讨其机制是否与高脂肠内营养支持调节机体的交感和迷走神经活性,从而启动胆碱能抗炎有关。方法选取河北北方学院附属第一医院住院脓毒症患者60例和同期体检健康志愿者30例作为研究对象。脓毒症患者根据肠内营养方案的不同分为脓毒症+常规肠内营养组和脓毒症+高脂肠内营养组;体检健康志愿者纳入正常对照组。脓毒症患者治疗14 d后,进行生存分析;健康志愿者、脓毒症患者在治疗前及营养支持14 d后收集血液标本,检测肠屏障功能检测;脓毒症患者在治疗前及营养支持14 d后通过心电监测评估交感和迷走神经活性。结果肠内营养支持14 d后,脓毒症患者常规肠内营养和高脂肠内营养的生存率分别为55.17%和67.86%,差异无统计学意义(P>0.05),但是高脂肠内营养支持组患者的肠屏障功能的恢复显著优于常规营养支持组(P<0.05);心电监护的时域分析结果显示,高脂肠内营养组患者反映迷走神经活性的高频功率显著高于常规营养组(P<0.05)。结论早期高脂肠内营养支持对脓毒症患者肠屏障功能具有明显的保护作用,其机制可能与高脂肠内营养支持活化胆碱能抗炎通路有关。

Objective The aim of this study was to observe whetheRearly high-fat enteral nutrition support could improve the prognosis of sepsis patients with conventional treatment,and to explore whetheRthe underlying mechanism was related to the regulation of high-fat enteral nutrition support on the body’s sympathetic and vagal nerve activity to activate cholinergic anti-inflammatory.Methods A total of 60 patients with sepsis hospitalized in the First Affiliated Hospital of Hebei North University and 30 healthy volunteers were enrolled in this study.Sepsis patients were divided into conventional enteral nutrition group and high-fat enteral nutrition group according to different enteral nutrition regimens.Meanwhile,healthy volunteers were included in the control group.AfteR14 days of sepsis treatment,survival analysis was performed.Blood samples were collected from healthy volunteers and sepsis patients before treatment and 14 days afteRnutritional support to detect intestinal barrieRfunction.Sympathetic and vagal activity was assessed by electrocardiographic(ECG)monitoring in septic patients before treatment and 14 days afteRnutritional support.Results AfteR14 days of enteral nutrition support,the survival rates of sepsis patients with conventional enteral nutrition and high-fat enteral nutrition were 55%and 68%,respectively,with no significant differences(P>0.05).However,the recovery of intestinal barrieRfunction in high-fat enteral nutrition group was significantly betteRthan that in the conventional nutrition support group(P<0.05).The time domain analysis of ECG monitoring showed that the high-frequency poweRreflecting vagal nerve activity was significantly higheRin the high-fat enteral nutrition group than in the conventional nutrition group(P<0.05).Conclusion Early high-fat enteral nutrition support has a significant protective effect on intestinal barrieRfunction in sepsis patients,and its mechanism may be related to the activation of cholinergic anti-inflammatory pathway by high-fat enteral nutrition.