ICU危重患者肠内营养支持的临床研究

目的：研究肠内营养支持对ICU危重患者的治疗效果。方法：ICU危重患者46例，随机分为肠内营养组26例和对照组20例，分别给予相同热量和氮量的肠内或肠外营养制剂。2组患者均于营养支持前与营养支持第8天检测T细胞亚群、自然杀伤（NK）细胞、血清白蛋白、血清前白蛋白、血红蛋白、上臂肌围和三头肌皮皱厚度。结果：肠内营养支持后，患者的CD3、CD。和血清前白蛋白明显增高（P〈0．01），CD4／CD8、NK细胞、血清白蛋白和血红蛋白增高（P〈0．05）；两组对比肠内营养支持后患者的CD3、CD4、CD4／CD8、NK细胞、血清前白蛋白和血清白蛋白均高于对照组肠外营养支持后（P〈0．05），而上臂肌围和三头肌皮皱厚度差异无显著性。结论：肠内营养支持不但可明显改善危重患者的营养状况，而且可改善其细胞免疫功能，只要病情许可应尽量采用肠内营养支持。

Clinical study of enteral nutritional support to critically ill patients

Objective:To investigate the remedial effect of enteral nutrition (EN) on critically ill patients in ICU.Methods:46 critically ill patients in ICU were randomly assigned to two groups:an enteral nutrition one of 26 patients and a control one of 20 patients.Both the two groups were given enteral or parenteral nutritional preparations of the same quantity of heat and nitrogen.Before and 8 days after nutritional support was given, T-cell subpopulations and NK cell and serum albumin and serum forealbumin and hemoglobin levels were determined, and the thickness of skin fold at musculus triceps brachii and muscular perimeter of the arm were measured.Results:It was found that CD_3,CD_4 and serum forealbumin were marked improved(P<0.01) and that CD_4/CD_8,NK cell,serum albumin and hemoglobin were elevated (P<0.05) in patients after EN support.Compared with the control group after parenteral nutrition suppport.CD_3,CD_4,CD_4/CD_8,NK cell,serum forealbumin, serum albumin and hemoglobin were increased (P<0.05).However,the thickness of skin fold at musculus triceps brachii and muscular perimeter of the arm were not different in the two groups.Conclusions:Enteral nutritional support might not only ameliorate nutritional state but also improve cellular immune function of critically ill patients.If only state of an illness permits,critically ill patients should accept enteral nutrition.