早期免疫型肠内营养对全身炎症反应综合征影响的临床研究

目的：观察早期免疫型肠内营养治疗全身炎症反应综合征的临床疗效、血清炎症细胞因子及免疫球蛋白水平的变化。方法：选择我院重症医学科（ICU）全身炎症反应综合征患者70例,按随机数字表法分为对照组（34例）和试验组（36例）。两组一般治疗措施相同,对照组给予常规肠内营养,试验组在常规营养支持基础上每日添加生理需要量的鱼油、谷氨酰胺及精氨酸。两组均治疗7 d。两组于治疗前后行急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ）和SIRS评分,检测C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素（IL-1、IL-6I、L-8）、免疫球蛋白（Ig G、Ig A、Ig M）水平。结果：两组治疗前APACHEⅡ、SIRS评分,CRP、TNF-α、IL-1、IL-6I、L-8、Ig G、Ig A、Ig M水平比较,差异无统计学意义（均P〉0.05）。与对照组比较,试验组治疗后APACHEⅡ、SIRS评分,CRP、TNF-α、IL-1、IL-6、IL-8下降更为显著（均P〈0.05）;Ig G、Ig A、Ig M显著增高（均P〈0.05）。结论：早期免疫型肠内营养能提高患者免疫功能,减轻全身炎症反应程度,促进患者康复。

Clinical study on effects of early enteral immunonutrition on critical patients with systemic inflammatory response syndrome

Objective： To observe the clinical effects of early enteral immunonutrition on critical patients with systemic inflammatory response syndrome （SIRS） and its influence on levels of serum inflammatory cytokine and immunogbulin. Methods： Seventy patients with SIRS in ICU were randomly divided into experimental group （36 cases） and control group （34 cases）. Control group accepted routine enteral nutrition, while experimental group accepted fish oil, glutamine and arginine based on the therapy of control group every day. Both groups were treated for 7 days. The acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score and SIRS score were estimated, and the parameters of Creactive protein （ CRP）, tumor necrosis factor- α （ TNF-α）, interleukins （ IL- 1, IL-6, IL-8 ）, immunogbulin（ IgG, IgA, IgM） in two groups were tested. Results. There were no statistical significant differences in APACHE Ⅱ score, SIRS score, CRP, serum inflammatory cytokine and immunogbulin levels before treatment between the two groups （ all P 〉 0. 05）. Compared with the control group, in the experimental group, the APACHE Ⅱ scores, SIRS scores, CRP, TNF- α, IL- 1, IL- 6, IL- 8 were significantly lower （ all P 〈 0. 05 ）, the immunogbulin IgG, IgA, IgM were significantly higher（ all P 〈 0. 05 ）. Conclusion： Early enteral immunonutrition can strengthen immune function, reduce the degree of acute inflammatory response and encourage rehabilitation.