早期肠内营养对重症肺炎合并胃肠功能障碍患者肠黏膜屏障功能及预后的影响

目的 观察早期肠内营养(EEN)对重症肺炎合并急性胃肠功能损伤(AGI)患者肠黏膜屏障功能及短期临床预后的影响。 方法 选取蚌埠医学院第二附属医院重症医学科于2018年1月—2019年12月收治的60例重症肺炎合并AGIⅡ级的患者,按随机数字表法分为观察组(EEN组)和对照组(LEN组)各30例,观察组在入科后24~48 h内启动肠内营养,对照组在入科72 h以后启动肠内营养。比较2组喂养不耐受的发生率、ICU住院时间、机械通气时间、治疗前后APACHEⅡ评分及28 d病死率;观察2组D-乳酸、二胺氧化酶(DAO)、降钙素原(PCT)、C反应蛋白(CRP)的变化情况。 结果 2组喂养不耐受的发生率(33.33%vs. 26.67%)与28 d病死率(20.00%vs. 23.33%)比较差异无统计学意义(均P>0.05),观察组ICU住院时间、机械通气时间、治疗后APACHEⅡ评分明显低于对照组(均P<0.05),2组治疗后血清D-乳酸、DAO、PCT、CRP水平较治疗前明显降低,且观察组明显低于对照组(均P<0.05)。 结论 对于重症肺炎合并AGI患者,EEN可以保护肠屏障功能、减轻全身炎症反应,喂养不耐受发生率较低,但对短期预后无改善。 

Effect of early enteral nutrition on intestinal barrier function and prognosis in patients with severe pneumonia combined gastrointestinal dysfunction

Objective To observe the influence of early enteral nutrition(EEN) on intestinal barrier function and prognosis in patients with severe pneumonia(SP) combined acute gastrointestinal injury(AGI). Methods Total 60 patients with SP and AGI Ⅱ admitted to the ICU of the Second Affiliated Hospital of Bengbu Medical Collage from January 2018 to December 2019 were randomly divided into observation group(EEN group) and control group(LEN group), 30 cases in each group. The observation group received EN within 24-48 hours, while the control group received EN after 72 hours. The feeding intolerance rate, length of ICU stay, length of mechanical ventilation, APACHE Ⅱ score, 28-days mortality(20.00% vs. 23.3%), and levels of D-lactate, diamine oxidase(DAO), procalcitonin(PCT), C-reactive protein(CRP) were compared between the two groups. Results No significant differences were found on feeding intolerance rate and 28-days mortality between the two groups(all P>0.05). The length of ICU stay, length of mechanical ventilation, APACHE Ⅱ score after treatment in the observation group were shorter than those in the control group(all P<0.05). After treatment, the levels of serum D-lactate, DAO, PCT and CRP decreased in both groups, and those in the observation group was obvious lower than those in the control group(all P<0.05). Conclusion EEN can improve intestinal barrier function, reduce inflammation, and with a low incidence rate of feeding intolerance in patients with SP combined AGI. However, it has no ameliorative effect on short-term prognosis.