营养支持对体外循环术后病人营养状况和免疫功能的影响

目的:探讨体外循环心内直视术后应用肠内营养支持的营养和免疫作用. 方法:将60例体外循环心内直视术后病人随机分为对照组和试验组(n=30).对照组自由进食,试验组在自由进食基础上,额外补充肠内营养3 138 kJ/d,连续7天.检测术前、术后第1、8天血清清蛋白(ALB)、转铁蛋白(TF)、前清蛋白(PA)以及术前、术后第1、4、8天T淋巴细胞亚群(CD3、CD4、CD8、CD4/CD8)、自然杀伤(NK)细胞活性、可溶性白细胞介素2受体(SIL-2R)等指标. 结果:两组病人术后第1天营养状况及免疫功能均迅速下降?vP<0.01).术后第4天,试验组CD4 已恢复,D8 明显下降(P<0.05),对照组CD4 仍低于术前水平(P<0.05).两组NK细胞活性均低于术前(P<0.01),试验组术后第4天SIL-2R已恢复,与对照组比差异有显著性意义(P<0.05).术后第8天,试验组血清蛋白质水平(ALB、TF、PA)明显高于对照组,差异有显著性意义(P<0.01).试验组CD4 /CD8 比值明显高于术前(P<0.05),两组CD4 、CD8 和SIL-2R水平均已恢复至术前水平,K细胞活性均未恢复(P<0.01).对照组感染性并发症率高达13.3%(4/30),试验组无感染性并发症的发生. 结论:肠内营养支持能改善体外循环术后病人的营养状况及免疫功能.

Effect of enteral nutrition support on the nutrition status and immune function in patients of cardiopulmonary bypass

Objectives:To investigate the effect of enteral nutrition support on improving the nutritional status and the immune function for patients after open heart operation under cardiopulmonary bypass(CPB). Methods:Sixty patients having valve replacement for rheumatic heart valvular disease were randomly divided into two group,control group and experimental group, 30 cases in each group. In control group patients ate freely, and in experimental group patients took orally 3 138 kJ nutritional fluid on the basic of eating freely every day after CPB.The study lasted for one week. Nutritional and immunological index were measured before and 1, 4,8d after CPB. Results:On lst day after CPB, nutrition status and immune function were decreased quickly in two groups(P<0.01). On 4th postoperative day, T-helper cells(CD4 +) were returned to the preoperative levels and T-suppressor cells(CD8 +) were lower signifiantly in the experimental group(P<0.05).CD4 + cells were decreased obviously in both groups.There was significant difference in the soluble interleukin-2 receptor (SIL-2R) levels (P<0.05). On 8th postoperative day, the levels of plasma albumin(ALB), tranferrin (TF) and prealbumin (PA) in the experimental group were significantly higher than in control groups(P<0.01). CD4 +/ CD8 + ratio was higher than before operation in the experimental group(P< 0.05 ).The infectious complication rate was 13.3%(4/30) in the control group. Conclusion:Nutrition support can improve the nutritional status and the immune function in patients after CPB.