【摘要】 目的探讨肠内营养联合微生态制剂对慢性阻塞性肺疾病急性加重机械通气患者消化道并发症、肠黏膜屏障功能、炎症反应的影响。方法 2015年1月至2016年12月收治的慢性阻塞性肺疾病急性加重机械通气患者96例,按照随机数字表法分为对照组(肠内营养组)和试验组(肠内营养联合微生态制剂组),每组各48例。比较两组患者消化道并发症、APACHEⅡ评分、机械通气时间、14d内撤机成功率和住院天数。酶学分光光度计法测定血清二胺氧化酶和肠型脂肪酸结合蛋白浓度。双抗体夹心酶联免疫吸附测定法(ELISA)试剂盒检测血清前降钙素原和C-反应蛋白浓度。结果肠内营养实施14d内,试验组胃潴留、腹胀、腹泻的发生率明显低于对照组(P<0.05);与对照组比较,试验组在肠内营养后第7天肠黏膜屏障功能指标二胺氧化酶(DAO)和血清肠型脂肪酸结合蛋白(I-FABP)表达降低(DAO:5.25±0.37mg/Lvs 6.93±0.58mg/L,t=4.8950,P=0.0328;I-FABP:31.89±3.05μg/Lvs40.62±4.63μg/L,t=13.7481,P=0.0047);血炎症细胞数和血清炎症因子表达明显降低(WBC:11.14±0.83×109/Lvs 3.78±0.94×109/L,t=8.8832,P=0.0163;中性粒细胞比例(N%):74.09±1.94%vs 78.64±2.68%,t=4.3332,P=0.0353;PCT:6.70±0.61μg/L vs 8.80±0.93μg/L,t=6.1109,P=0.0280;CRP:111.45±12.29mg/L vs 143.80±13.33mg/L,t=15.3342,P=0.0014)。肠内营养联合微生态制剂能有效改善COPD急性加重机械通气患者病情,在第14天APACHEⅡ评分低于对照组(12.52±1.19 vs 14.69±1.34,t=6.7432,P=0.0421)。结论对于慢性阻塞性肺疾病急性加重机械通气患者,肠内营养联合微生态制剂能够有效降低患者消化道并发症发生率,改善肠黏膜屏障功能,抑制炎症反应,进而改善患者病情,值得临床推广使用。更多还原

【Abstract】 Objective To explore the effects of enteral nutrition combined with microecologics on the incidences of gastrointestinal complications,intestinal mucosal barrier function,inflammatory response and prognosis in patients with acute exacerbated chronic obstructive pulmonary disease(AECOPD)undergoing mechanical ventilation.Methods 96 patients with AECOPD admitted from January 2015 to December 2017 were randomly divided into the experiment group(n=48)or control group(n=48).After 14 days of treatment,the incidences of gastrointestinal complications,APACHEⅡscores and prognosis were compared between groups.The intestinal mucosal barrier function indexes,diamine oxidase(DAO)and intestinal fat acid binding protein(I-FABP),were evaluated with enzymatic spectrophotometer method.The serum levels of procalcitonin(PCT)and C-reactive protein(CRP)were detected with enzyme linked immunosorbent assay(ELISA).Results The experiment group had lower incidences of gastric retention,abdominal distension and diarrhea 14 days after enteral nutrition supplement as compared with the control group(P<0.05);The DAO and I-FABP decreased on the 7 th day after enteral nutrition combined with microecologic(DAO 5.25±0.37 mg/L vs 6.93±0.58 mg/L,t=4.8950,P=0.0328;I-FABP 31.89±3.05μg/L vs40.62±4.63μg/L,t=13.7481,P=0.0047,respectively);The inflammatory responses in the experiment group significantly reduced on the 7 th day after microecological supplement(WBC 11.14±0.83×109/L vs3.78±0.94×109/L,t=8.8832,P=0.0163;N% 74.09±1.94% vs 78.64±2.68%,t=4.3332,P=0.0353;PCT 6.70±0.61μg/Lvs 8.80±0.93μg/L,t=6.1109,P=0.0280;CRP 111.45±12.29 mg/Lvs143.80±13.33 mg/L,t=15.3342,P=0.0014,respectively).The experiment group received better prognosis compared to the control group,with a lower APACHEⅡscores(12.52±1.19 vs 14.69±1.34,t=6.7432,P=0.0421)on the 14 th day.Conclusion Enteral nutrition combined with microecologics can effectively reduce the incidences of gastrointestinal complications,alleviate intestinal mucosal barrier function damage and the inflammatory responses in patients with AECOPD undergoing mechanical ventilation,and possibly improve prognosis.更多还原