添加益生菌的早期肠内营养对脓毒血症休克患者TNF-α和IL-6的影响

摘要

目的：探讨添加益生菌的肠内营养对脓毒血症休克患者外周血促炎因子肿瘤坏死因子α（TNF-α）及白细胞介素6（IL-6）影响，对病情及预后的影响。方法对42例脓毒血症休克患者，进行随机分组，分为EEN组（早期肠内营养组）22例及EENP组（添加益生菌的早期肠内营养组）20例，并设立健康人26例为正常对照组。EEN组在积极控制感染及相应措施同时于入住ICU 6~12 h后采用肠内营养制剂（能全力）开始营养支持，而EENP组在此基础上于前14天添加培菲康，在肠内营养支持前、入院第3、7、15天，分别收集外周血TNF-α、IL-6水平并进行病情评分（采用APEACHⅡ评分）。结果营养支持0 d，EEN组和EENP组外周血TNF-α和IL-6含量高于C组，具有显著性差异（P＜0.01）；EEN组和EENP组间差异无统计学意义（P＞0.05）；营养支持3 d，两组患者外周血TNF-α和IL-6差异无统计学意义（P＞0.05）；营养支持7 d及15 d，EENP组TNF-α和IL-6均低于EEN组（P＜0.05），但与C组相比，均未恢复至正常水平（P＜0.05）。整个研究期间两组患者APEACHⅡ评分比较差异无统计学意义（P＞0.05）。结论在脓毒血症休克患者中进行早期肠内营养并添加益生菌有助于降低TNF-α、IL-6水平，有助于减轻脓毒症状表现，值得推广应用。%Objectives To probe in to influence of early enteral nutrition supplemented with probiotics on TNF-аand IL-6 of patients with septic shock, and the influence on disease changes and prognosis of the patients. Methods A number of 42 patients with septic shock were randomly assigned into two groups, early enteral nutrition group (group EEN, including 22 patients) and early enteral nutrition combined with probiotics group (group EENP, including 20 patients). And normal group (including 26 patients) was set up. Patients in group EEN got enteral nutrition (Nutrison Fibre) within 6-12 hours after sent to ICU besides the necessary treatments on the septic shock. In addition to the same treatments as the group EEN, patients in group EENP took Bifico within the first 14 days. Peripheral blood was collected before enteral nutrition support (0th day) and at the 3rd, 7th, 15th day for dynamic observation of TNF-аand IL-6, and evaluate the patient's condition by acute physiology and chronic health evaluationⅡ(APEACHⅡ) at the same time. Results On nutritional support 0th day, TNF-аand IL-6 in peripheral blood in both of the group EEN and group EENP were higher than the normal group, and had significant differences(P<0.01). There were no significant differences(P>0.05) on TNF-аand IL-6 in peripheral blood between group EEN and group EENP at the 0th and 3rd day. On the 7th, 15th day , TNF-аand IL-6 in peripheral blood in group EENP were lower than the group EEN, but higher than the normal group, and the differences were all significant (P<0.05). The differences of APEACHⅡscores between group EEN and group EENP were not significant over the study period(P>0.05). Conclusion Add probiotic in early enteral nutrition in patients with septic shock can helps reduce TNF-аand IL-6, and reduce the extent of the infection, and improve the prognosis of septic patients and it deserve applying extends.