早期肠内营养护理对危重病人营养指标及免疫功能的影响

Effects of Early Enteral Nutrition Nursing on Nutritional Indexes and Immune Function in Critically Ill Patients

摘要: 目的：探讨早期肠内营养(EEN)护理对危重病人营养指标及免疫功能的影响。方法：回顾性分析2017年6月~2018年6月间于我院重症监护室住院治疗的122例危重病人临床资料，根据营养支持方案分为观察组(n = 62)和对照组(n = 60)。观察组行EEN，对照组行肠外营养和肠内序贯营养。比较两组2w存活率、ICU住院时间，评估两组干预前、干预10 d后营养指标[总蛋白(TP)、前白蛋白(PA)、转铁蛋白(TF)]、免疫功能[T淋巴细胞亚群、免疫球蛋白A (IgA)]、病情变化情况[急性生理学与慢性健康状况Ⅱ (APACHE II)]，记录两组患者并发症发生率。结果：1) 两组2w存活率对比，差异无统计学意义(P > 0.05)；观察组ICU住院时间短于对照组(P < 0.05)；2) 干预10 d后，两组TP、PA、TF水平均高于干预前(P < 0.05)，观察组增幅均大于对照组(P < 0.05)；3) 干预10 d，两组IgA、CD4+、CD4+/CD8+水平均高于干预前(P < 0.05)，观察组增幅大于对照组(P < 0.05)；4) 干预10 d后，两组APACHE II得分均降低(P < 0.05)，观察组降幅大于对照组(P < 0.05)；5) 两组恶心呕吐、反流误吸及腹泻发生率对比，差异无统计学意义(P > 0.05)；观察组胃潴留发生率低于对照组(P < 0.05)。结论：EEN有利于提高危重病人营养指标及免疫功能，还能对改善病情状况起积极作用。

Abstract: Objective: To explore the effects of early enteral nutrition (EEN) nursing on nutritional indexes and immune function in critically ill patients. Methods: The clinical data of 122 critically ill patients hospitalized in the intensive care unit of our hospital from June 2017 to June 2018 were re-trospectively analyzed. According to the nutritional support program, they were divided into ob-servation group (n = 62) and control group (n = 60). Observation group was treated with EEN, and control group was given parenteral nutrition and intestinal sequential nutrition. The 2w survival rate and ICU stay were compared between the two groups. The nutritional indicators [total protein (TP), prealbumin (PA), transferrin (TF)], immune function [T lymphocytes subsets, immunoglobulin A (IgA)] and disease condition [acute physiology and chronic health evaluation II (APACHE II)] were evaluated before intervention and after 10 d of intervention. And the incidence rate of complications was recorded in the two groups. Results: There was no significant difference in 2w survival rate between the two groups (P > 0.05). The ICU stay in observation group was shorter than that in control group (P < 0.05). After 10 d of intervention, the levels of TP, PA and TF in the two groups were higher than those before intervention (P < 0.05), and the increase in observation group was greater than that in control group (P < 0.05). After 10 d of intervention, the levels IgA, CD4+, CD4+/CD8+ in the two groups were higher than those before intervention (P < 0.05), and the increases in observation group were greater than those in control group (P < 0.05). After 10d of intervention, the APACHE II scores in the two groups were decreased (P < 0.05), and the decrease in observation group was greater than that in control group (P < 0.05). There were no significant differences in the incidence rates of nausea and vomiting, reflux aspiration and diarrhea (P > 0.05). The incidence rate of gastric retention in observation group was lower than that in control group (P < 0.05). Conclusions: EEN is beneficial to improve the nutritional indexes and immune function of critically ill patients, and it can also play a positive role in improving the disease condition.