早期肠内营养对严重腹部创伤术后患者营养状态、免疫功能和肠屏障功能的影响
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摘要
目的:探讨早期肠内营养对严重腹部创伤术后患者营养状态、免疫功能和肠屏障功能的影响。方法:选取2016年1月-2017年10月因严重腹部创伤于本院行手术治疗的80例患者作为研究对象,按照随机数字表法将其分为对照组和观察组,各40例。对照组采用延迟肠内营养,观察组采用早期肠内营养,比较两组14 d后临床疗效。结果:治疗后观察组血红蛋白(HB)、白蛋白(Alb)营养状态指标均明显高于对照组,差异均有统计学意义(P<0.05);治疗后观察组CD4~+/CD8~+水平明显高于对照组,D-乳酸水平明显低于对照组,差异均有统计学意义(P<0.05);观察组并发症总发生率为10.0%(4/40)与对照组的12.50%(5/40)比较,差异无统计学意义(X~2=0.125,P>0.05)。结论:对于严重腹部创伤术后患者而言早期肠内营养具有重要意义,有助于改善营养状态,预防免疫抑制,保护肠黏膜功能,值得推广。
Objective:To investigate the effects of early enteral nutrition on nutritional status,immune function and intestinal barrier function in patients with severe abdominal trauma after surgery.Method: A total of 80 patients with severe abdominal trauma undergone surgical treatment in our hospital from January 2016 to October 2017 were selected as study objects.According to the random number table method,they were divided into control group and observation group,40 cases in each group.The control group were treated with delayed enteral nutrition,the observation group were treated with early enteral nutrition.The clinical effects of the two groups were compared after 14 days.Result:After treatment,the nutritional status indexes of hemoglobin(HB)and albumin(Alb) in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).The level of CD4~+/CD8~+ in the observation group was significantly higher than that in the control group,and the level of D-lactic acid in the observation group was significantly lower than that in the control group,the differences were statistically significant(P<0.05).The total incidence of complications in the observation group was 10.0%(4/40), compared with 12.5%(5/40) in the observation group,the difference was not statistically significant( X~2=0.125,P>0.05).Conclusion:Early enteral nutrition is of great importance for patients with severe abdominal trauma.It is helpful to improve nutritional status,prevent immunosuppression and protect intestinal mucosal function,and is worthy of promotion.
Objective:To investigate the effects of early enteral nutrition on nutritional status,immune function and intestinal barrier function in patients with severe abdominal trauma after surgery.Method: A total of 80 patients with severe abdominal trauma undergone surgical treatment in our hospital from January 2016 to October 2017 were selected as study objects.According to the random number table method,they were divided into control group and observation group,40 cases in each group.The control group were treated with delayed enteral nutrition,the observation group were treated with early enteral nutrition.The clinical effects of the two groups were compared after 14 days.Result:After treatment,the nutritional status indexes of hemoglobin(HB)and albumin(Alb) in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).The level of CD4~+/CD8~+ in the observation group was significantly higher than that in the control group,and the level of D-lactic acid in the observation group was significantly lower than that in the control group,the differences were statistically significant(P<0.05).The total incidence of complications in the observation group was 10.0%(4/40), compared with 12.5%(5/40) in the observation group,the difference was not statistically significant( X~2=0.125,P>0.05).Conclusion:Early enteral nutrition is of great importance for patients with severe abdominal trauma.It is helpful to improve nutritional status,prevent immunosuppression and protect intestinal mucosal function,and is worthy of promotion.
引文
[1]蒋辉.加味黄连解毒汤灌肠对重症腹部外科术后患者胃肠功能障碍的影响[J].现代中西医结合杂志,2016,25(34):3829-3831.
[2]吴日英,黄英隆,黄静芳,等.胃肠肿瘤病人术后两种促进胃肠功能恢复方法的效果观察[J].护理研究,2014,35(22):2741-2742.
[3]李伟,孟宪萌.通腹汤促进腹部手术术后胃肠功能恢复随机平行对照研究[J].实用中医内科杂志,2013,27(3):21-23.
[5]赵旭明,秦陈浩,刘励军,等.严重创伤患者免疫功能抑制的影响因素[J].江苏医药,2014,40(7):785-788.
[6]薛欣,王志永,刘建刚,等.重度烧伤并发脓毒症及治疗与血清IL-6,TNF-α,IL-10水平的相关性分析[J].现代中西医结合杂志,2015,24(6):636-638.
[7]孙羽.不同营养方式对严重腹部创伤术后患者营养状态和肠屏障功能的影响[J].重庆医学,2016,45(1):97-99.
[8]王阿凤,陆关珍.胸腹部创伤合并失血性休克的术前限制性液体复苏的疗效评价[J].中国实用护理杂志,2014,30(13):45-47.
[9]耿延青.脓毒症患者血中CD4+、CD25+调节性T细胞水平与机体细胞免疫状态的相关性研究[J].中国医药导报,2015,3(2):7-10.
[10]王钟舟,刘勇帆,张文广.不同手术方式对急性化脓性阑尾炎患者免疫球蛋白及细胞因子的影响[J].江西医药,2015,50(10):1041-1043.
[11]刘慧琳,刘桂花,田兆兴.脓毒症患者血中淋巴细胞水平的变化[J].中华危重病医学,2014,26(3):148-152.
[12]雷李美,蓝翔,考验.参附注射液对严重创伤患者T细胞亚群、天然杀伤细胞及预后的影响[J].中华全科医学,2016,14(5):743-745.
[13]Marik P E,Flemmer M.The immune response to surgery and trauma:Implications for treatment[J].Journal of Trauma and Acute Care Surgery,2012,73(4):801-808.
[14]王滨,边瑞民,魏传梅,等.头孢地嗪增加老年细菌性肺炎患者外周血CD4/CD8和Th1/Th2细胞比例[J].细胞与分子免疫学杂志,2015,4(13):528-531.
[15]蒋欢,蒋丽琳,张凯.早期肠内营养联合双歧杆菌三联活菌胶囊治疗重症急性胰腺炎的疗效及对炎性因子、肠黏膜屏障功能保护的影响[J].海南医学院报,2015,21(11):1496-1498.
[16]谢玉宏.损伤控制性外科理论在合并腹部创伤的严重多发伤的应用分析[J].实用临床医药杂志,2014,18(5):45.
[17]吴玲.探讨腹部创伤并伴有高血压患者急诊手术的护理配合效果[J/OL].中西医结合心血管病电子杂志,2015,56(4):150-152.
[18]朱亚兰.胃大部切除术后早期肠内营养与延迟肠内营养的对比分析[J].中国民族民间医药,2013,22(18):48-49.
[19]姚红兵,曾荣城,文明波,等.早期肠内营养与延迟肠内营养治疗重症急性胰腺炎的临床疗效比较[J].实用医学杂志,2014,30(14):2231-2233.
[2]吴日英,黄英隆,黄静芳,等.胃肠肿瘤病人术后两种促进胃肠功能恢复方法的效果观察[J].护理研究,2014,35(22):2741-2742.
[3]李伟,孟宪萌.通腹汤促进腹部手术术后胃肠功能恢复随机平行对照研究[J].实用中医内科杂志,2013,27(3):21-23.
[5]赵旭明,秦陈浩,刘励军,等.严重创伤患者免疫功能抑制的影响因素[J].江苏医药,2014,40(7):785-788.
[6]薛欣,王志永,刘建刚,等.重度烧伤并发脓毒症及治疗与血清IL-6,TNF-α,IL-10水平的相关性分析[J].现代中西医结合杂志,2015,24(6):636-638.
[7]孙羽.不同营养方式对严重腹部创伤术后患者营养状态和肠屏障功能的影响[J].重庆医学,2016,45(1):97-99.
[8]王阿凤,陆关珍.胸腹部创伤合并失血性休克的术前限制性液体复苏的疗效评价[J].中国实用护理杂志,2014,30(13):45-47.
[9]耿延青.脓毒症患者血中CD4+、CD25+调节性T细胞水平与机体细胞免疫状态的相关性研究[J].中国医药导报,2015,3(2):7-10.
[10]王钟舟,刘勇帆,张文广.不同手术方式对急性化脓性阑尾炎患者免疫球蛋白及细胞因子的影响[J].江西医药,2015,50(10):1041-1043.
[11]刘慧琳,刘桂花,田兆兴.脓毒症患者血中淋巴细胞水平的变化[J].中华危重病医学,2014,26(3):148-152.
[12]雷李美,蓝翔,考验.参附注射液对严重创伤患者T细胞亚群、天然杀伤细胞及预后的影响[J].中华全科医学,2016,14(5):743-745.
[13]Marik P E,Flemmer M.The immune response to surgery and trauma:Implications for treatment[J].Journal of Trauma and Acute Care Surgery,2012,73(4):801-808.
[14]王滨,边瑞民,魏传梅,等.头孢地嗪增加老年细菌性肺炎患者外周血CD4/CD8和Th1/Th2细胞比例[J].细胞与分子免疫学杂志,2015,4(13):528-531.
[15]蒋欢,蒋丽琳,张凯.早期肠内营养联合双歧杆菌三联活菌胶囊治疗重症急性胰腺炎的疗效及对炎性因子、肠黏膜屏障功能保护的影响[J].海南医学院报,2015,21(11):1496-1498.
[16]谢玉宏.损伤控制性外科理论在合并腹部创伤的严重多发伤的应用分析[J].实用临床医药杂志,2014,18(5):45.
[17]吴玲.探讨腹部创伤并伴有高血压患者急诊手术的护理配合效果[J/OL].中西医结合心血管病电子杂志,2015,56(4):150-152.
[18]朱亚兰.胃大部切除术后早期肠内营养与延迟肠内营养的对比分析[J].中国民族民间医药,2013,22(18):48-49.
[19]姚红兵,曾荣城,文明波,等.早期肠内营养与延迟肠内营养治疗重症急性胰腺炎的临床疗效比较[J].实用医学杂志,2014,30(14):2231-2233.