经三腔二囊管行肠内营养对老年食管-胃底静脉曲张破裂出血患者预后及免疫功能的影响

目的 探讨经三腔二囊管行肠内营养对老年食管-胃底静脉曲张破裂出血(GEVB)患者预后及免疫功能的影响.方法 回顾性分析武警北京市总队医院2013年2月—2016年2月胸外科收治的GEVB进行三腔二囊管急救止血110例,按营养方法不同分为观察组与对照组,每组55例,观察组采用三腔二囊管行肠内营养,对照组采用静脉肠外营养,配合口服肠内营养乳剂.观察并比较两组止血效果、营养指标、生化指标及免疫功能情况.结果 两组再出血率比较差异无统计学意义(P>0.05).两组治疗前上臂肌围、三头肌皮褶厚度、体质量比较差异无统计学意义(P>0.05),治疗1周后,观察组上臂肌围和体质量增高幅度均大于对照组(P<0.05).两组治疗前血红蛋白(Hb)、血小板(PLT)、白蛋白(Alb)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBil)、凝血酶原时间(PT)等各项指标比较差异无统计学意义(P>0.05),治疗1周后,观察组Alb增加、PT缩短时间明显大于对照组(P<0.05).两组治疗1周后CD3+、CD4+、CD4+/CD8+值均较治疗前增高(P<0.05),观察组CD3+、CD4+、CD4+/CD8+值增高明显大于对照组(P<0.05).结论 经三腔二囊管肠内营养对老年GEVB患者可有效止血并防止治疗后短期再出血,有助于早期营养物质合成以及机体各项功能达标,提高免疫功能和预后水平.

Effect of Enteral Nutrition through Sengstaken Blakemore Tube on Prognosis and Immune Function of Elderly Patients with Gastro Esophageal Variceal Bleeding

Objective To investigate effect of enteral nutrition through Sengstaken Blakemore tube on prognosis and immune function of elderly patients with gastro esophageal variceal bleeding (GEVB). Methods Clinical data of 110 GEVB patients treated through Sengstaken Blakemore tube admitted during February 2013 and February 2016 was retrospectively analyzed, and the patients were divided into observation group and control group ( n=55 for each group) according to different nutritional methods. Observation group received enteral nutrition through Sengstaken Blakemore tube, while control group was treated by intravenous parenteral nutrition combined with enteral nutrition emulsion orally. Hemostasis effect, nutrition indexes, biochemistry indexes and immune function in the two groups were observed and compared. Results There was no significant difference in rebleeding rate between the two groups (P>0. 05). Before treatment, there were no significant differences in values of arm muscle circumference, triceps skinfold thickness and body weight between the two groups (P>0. 05). After one week of treatment, increased amplitude values of arm muscle circumference and body mass of observation group were significantly higher than those of control group (P<0. 05). Be-fore treatment, there were no significant differences in values of hemoglobin ( Hb) , blood platelet count ( BPC) , albumin ( ALB) , aspartate transaminase ( AST) , alanine transarninase ( ALT) , total bilirubin ( TB) and prothrombin time ( PT) between the two groups (P>0. 05). After one week of treatment, in observation group, ALB value was increased, and PT was shorter, and the changes were significantly larger than those in control group (P<0. 05);levels of CD3 +, CD4+, CD4 +/CD8 + were significantly higher than those before treatment in two groups (P<0. 05), and the increased levels of CD3 +, CD4 +, CD4 +/CD8 + in observation group were more significantly than those in control group ( P<0. 05). Conclusion Sengstaken Blakemore tube can effectively stop bleeding and prevent short-term rebleeding after treatment in elderly patients with GEVB. It can help early synthesis of nutrients and indexes up to the standard, improve the immune function and prognosis.