ω-3多不饱和脂肪酸营养液对ARDS机械通气患者临床疗效的影响

摘要

目的 观察富含ω-3多不饱和脂肪酸(ω-3PUFA)的肠内营养(EN)液对机械通气治疗急性呼吸窘迫综合征(ARDS)患者临床疗效的影响.方法 采用前瞻性研究方法,选择2007年5月至2016年10月在湖州市中医院重症加强治疗病房(ICU)及呼吸科病房治疗的ARDS患者40例,按随机数字表法分为研究组和对照组,每组20例.两组分别给予相同热量不同配方的EN支持,研究组鼻饲富含ω-3PUFA的EN乳剂(TPF-T)瑞能,对照组鼻饲整蛋白纤维型EN混悬液(TPF)能全力,两组制定的目标能量均为104.0~125.5 kJ·kg-1·d-1.于治疗前及治疗后7 d观察两组营养状况指标〔总蛋白(TP)、白蛋白(ALB)〕、炎性指标〔C-反应蛋白(CRP)〕、免疫指标(T细胞亚群CD4、CD8、CD4/CD8)、血气分析指标〔动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)〕和机械通气时间、入住ICU时间及病死率的变化;并观察两组治疗过程中并发症的发生情况.结果 两组治疗后TP、ALB、CD4、CD4/CD8、PaO2、PaO2/FiO2均较治疗前升高,CRP、CD8均较治疗前降低,且研究组上述指标的改善程度优于对照组〔TP(g/L):59.9±4.8比58.6±4.1,ALB(g/L):31.9±3.4比31.1±4.4,CRP(mg/L):25.8±18.5比38.1±24.9,CD4:0.30±0.05比0.28±0.04,CD8:0.21±0.03比0.19±0.04,CD4/CD8:1.57±0.39比1.55±0.42,PaO2(mmHg,1 mmHg=0.133 kPa):152.7±15.8比140.6±22.2,PaO2/FiO2(mmHg):304.5±32.1比280.2±44.1〕;研究组存活患者机械通气时间(d:7.1±2.2比9.2±3.5)和入住ICU时间(d:10.4±2.8比12.6±3.6)均较对照组明显缩短(均P<0.05),两组病死率均为15.0%.结论 富含ω-3PUFA的EN制剂较整蛋白纤维型EN制剂更有利于ARDS患者呼吸功能的恢复,可缩短机械通气时间和入住ICU时间.%Objective To observe the clinical curative effect of enteral nutrition (EN) liquid rich in omega-3 polyunsaturated fatty acids (ω-3PUFA) for patients suffering from acute respiratory distress syndrome (ARDS) and treated with mechanical ventilation.Methods A prospective study was conducted, 40 patients with ARDS admitted and treated in the intensive care unit (ICU) and respiratory department in the Traditional Chinese Medicine Hospital of Huzhou from May 2007 to October 2016 were enrolled, and they were randomly divided into a study group and a control group, each group 20 cases. The same heat EN support of different prescriptions was given respectively in the two groups, nasal feeding with EN emulsion rich in ω-3PUFA (TPF-T) was applied in the study group, while in the control group, nasal feeding with EN suspension liquid of protein fiber type (TPF) was given, and the target energy established for the two groups was 104.0 - 125.5 kJ·kg-1·d-1. In the two groups, before and after treatment for 7 days, the changes of nutrition indexes [total protein (TP), albumin (ALB)], inflammatory index [C-reactive protein (CRP)], immune indexes (T cell subgroup CD4, CD8 and CD4/CD8), blood gas analysis indexes [arterial blood oxygen partial pressure (PaO2), oxygenation index (PaO2/FiO2)] and mechanical ventilation time, the length of stay in ICU and fatality rate were observed; the occurrences of false aspiration, feeding tube obstruction, high blood sugar, excessive water, diarrhea, constipation, etc. complications related to the process of the treatment were observed in the two groups. Results After treatment, the levels of TP, ALB, CD4, CD4/CD8, PaO2, PaO2/FiO2 in two groups were higher than those before treatment, the levels of CRP and CD8 were lower than those before treatment, and the improvement degrees of indexes in study group were superior to those in the control group [TP (g/L): 59.9±4.8 vs. 58.6±4.1, ALB (g/L): 31.9±3.4 vs. 31.1±4.4, CRP (mg/L): 25.8±18.5 vs. 38.1±24.9, CD4: 0.30±0.05 vs. 0.28±0.04, CD8: 0.21±0.03 vs. 0.19±0.04, CD4/CD8: 1.57±0.39 vs. 1.55±0.42, PaO2 (mmHg, 1 mmHg = 0.133 kPa): 152.7±15.8 vs. 140.6±22.2, PaO2/FiO2 (mmHg): 304.5±32.1 vs. 280.2±44.1]; the survival patient mechanical ventilation time (days: 7.1±2.2 vs. 9.2±3.5) and length of stay in ICU (days: 10.4±2.8 vs. 12.6±3.6) were significantly shorter in study group than those in control group (allP < 0.05), and fatality rate was 15.0%in both groups.Conclusion The EN liquid rich in ω-3PUFA is more beneficial to the recovery of respiratory function than EN of protein fiber type in patients with ARDS, and the former EN also can shorten the mechanical ventilation time and the length of stay in ICU.