早期肠内营养对严重腹部创伤术后患者营养状态、免疫功能和肠屏障功能的影响

曾宪国　陈黎新　陈自力

【摘要】 目的：探討早期肠内营养对严重腹部创伤术后患者营养状态、免疫功能和肠屏障功能的影响。方法：选取2016年1月-2017年10月因严重腹部创伤于本院行手术治疗的80例患者作为研究对象，按照随机数字表法将其分为对照组和观察组，各40例。对照组采用延迟肠内营养，观察组采用早期肠内营养，比较两组14 d后临床疗效。结果：治疗后观察组血红蛋白（HB）、白蛋白（Alb）营养状态指标均明显高于对照组，差异均有统计学意义（P<0.05）；治疗后观察组CD4+/CD8+水平明显高于对照组，D-乳酸水平明显低于对照组，差异均有统计学意义（P<0.05）；观察组并发症总发生率为10.0%（4/40）与对照组的12.50%（5/40）比较，差异无统计学意义（字2=0.125，P>0.05）。结论：对于严重腹部创伤术后患者而言早期肠内营养具有重要意义，有助于改善营养状态，预防免疫抑制，保护肠黏膜功能，值得推广。

【关键词】 早期肠内营养； 严重腹部创伤术后； 营养状态； 免疫功能； 肠屏障功能

Effects of Early Enteral Nutrition on Nutritional Status，Immune Function and Intestinal Barrier Function in Patients with Severe Abdominal Trauma after Surgery/ZENG Xianguo，CHEN Lixin，CHEN Zili，et al.//Medical Innovation of China，2018，15（16）：0-027

【Abstract】 Objective：To investigate the effects of early enteral nutrition on nutritional status，immune function and intestinal barrier function in patients with severe abdominal trauma after surgery.Method： A total of 80 patients with severe abdominal trauma undergone surgical treatment in our hospital from January 2016 to October 2017 were selected as study objects.According to the random number table method，they were divided into control group and observation group，40 cases in each group.The control group were treated with delayed enteral nutrition，the observation group were treated with early enteral nutrition.The clinical effects of the two groups were compared after 14 days.Result：After treatment，the nutritional status indexes of hemoglobin （HB）and albumin （Alb） in the observation group were significantly higher than those in the control group，the differences were statistically significant （P<0.05）.The level of CD4+/CD8+ in the observation group was significantly higher than that in the control group，and the level of D-lactic acid in the observation group was significantly lower than that in the control group，the differences were statistically significant （P<0.05）.The total incidence of complications in the observation group was 10.0% （4/40）， compared with 12.5% （5/40） in the observation group，the difference was not statistically significant （字2=0.125，P>0.05）.Conclusion：Early enteral nutrition is of great importance for patients with severe abdominal trauma.It is helpful to improve nutritional status，prevent immunosuppression and protect intestinal mucosal function，and is worthy of promotion.

【Key words】 Early enteral nutrition； Severe abdominal trauma； Nutritional status； Immune function； Intestinal barrier function

First-authors address：Chinese Peoples Liberation Army No.94 Hospital，Nanchang 330000，China

doi：10.3969/j.issn.1674-4985.2018.16.007

重症腹部创伤是外科常见的危重症，近年来随着交通工具的普及，该创伤的发生率逐渐升高，是导致患者死亡的重要原因。手术是其首选治疗措施，不少患者可因严重失血性休克而在1 h内死亡，而后发生的多脏器功能衰竭、感染则是导致后期患者死亡的关键原因[1]。研究表明，严重创伤可产生过度应激反应，提高机体新陈代谢，可使营养消耗增多，不利于疾病恢复。同时应激反应还可导致免疫功能紊乱，引起免疫抑制，表现为CD4+/CD8+、CD3+等T淋巴细胞水平明显降低，增大感染风险[2-3]。同时，严重创伤时受到应激刺激影响，胃肠道处于缺血缺氧状态，可引起肠道黏膜受损，从而导致肠道内毒素及细菌移位感染，甚至危及生命[2]。……