早期肠内营养干预对脓毒症休克患者免疫平衡及预后的影响

Effects of Early Enteral Nutrition Intervention on Immune Balance and Prognosis of Patients with Septic Shock

目的:总结早期肠内营养(EEN)干预对脓毒症休克患者免疫平衡和预后的影响。方法:选取2018年10月-2023年10月济源市人民医院收治的82例脓毒症休克患者为研究对象,根据其肠内营养(EN)干预方案分为EEN组(n=39)和晚期肠内营养(DEN)组(n=43),EEN组于入院24 h内予以EN,DEN组于入院48 h后予以EN,比较两组干预前后血清营养指标、免疫平衡指标、炎性因子变化和干预期间不良反应、入住ICU时间、干预前后急性生理与慢性健康(APACHEⅡ)评分、贯序器官功能衰竭(SOFA)评分。结果:干预7 d后,相较于DEN组,EEN组血清总蛋白(TP)、清蛋白(Alb)、前清蛋白(PA)水平更高,Treg/Th17、血清C反应蛋白(CRP)、白细胞介素(IL)-6水平、APACHEⅡ、SOFA评分更低(P<0.05);EEN组代谢紊乱发生率明显低于DEN组、EEN组入住ICU时间明显短于DEN组(P<0.05)。结论:EN干预可有效改善脓毒症休克患者的营养状态和免疫平衡,而EEN的效果更甚,可能对疾病恢复具有积极推进作用。

Objective:To summarize the effects of early enteral nutrition(EEN)intervention on immune balance and prognosis of patients with septic shock.Methods:A total of 82 patients with septic shock admitted to Jiyuan People's Hospital were enrolled from Oct 2018 to Oct 2023.According to different EN intervention methods,they were divided into EEN group(n=39,EN intervention within 24 h after admission)and DEN group(n=43,EN intervention within 48h after admission).The changes of serum nutritional indexes,immune balance indexes and inflammatory factors before and after intervention,and adverse reactions during intervention,the stay time in ICU,scores of acute physiologi-cal and chronic healthⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)before and after intervention were compared between the two groups.Results:Compared with DEN group after 7 d of intervention,levels of serum to-tal protein(TP),albumin(Alb)and prealbumin(PAB)were significantly higher in EEN group,while Treg/Th17,lev-els of serum C-reactive protein(CRP)and interleukin(IL)-6,scores of APACHEⅡand SOFA were significantly lower(P<0.05).The incidence of metabolic disorders in EEN group was significantly lower than that in DEN group,and stay time in ICU was significantly shorter than that in DEN group(P<0.05).Conclusion:EN intervention can effectively im-prove nutritional status and immune balance in patients with septic shock,and EEN is more effective,which may have positive impact on disease recovery.