肠内免疫微生态营养与肠内增强免疫营养在治疗重症肺炎的对比研究

摘要

目的 对比分析肠内免疫微生态营养、免疫增强型肠内营养对重症肺炎疗效、大便菌群变化情况、营养状态及预后的影响.方法 2015年6月-2016年12月,呼吸内科收治重症肺炎患者96例,采用随机数字表达法,A、B组各入组48例,分别给予A组肠内免疫微生态营养、B组免疫增强型肠内营养.同期因胃肠动力紊乱或胃肠道不耐受肠内营养的对象40例,纳入对照组.对比干预前、干预后1周、2周疗效(C反应蛋白CRP、D-二聚体、纤维蛋白原FIB、肺部感染评分CPIS)、大便菌群检查(大便菌群失调发生率)、营养状况指标(前清蛋白PAB、转铁蛋白TRF),预后(术后并发症与死亡).观察三组在治疗中的不良反应.结果第1周、第2周,组内对比三组CRP、D-二聚体、FIB、肺部感染评分CPIS水平低于干预前,组间对比A组第1、2周CRP、D-二聚体、FIB、肺部感染评分CPIS低于对照组、B组,B组低于对照组,差异有统计学意义(P<0.05).组间对比,A组、B组第1-2周PAB高于对照组,两组第1周TRF高于对照组,A组第2周PAB高于B组,差异有统计学意义(P<0.05).重症肺炎发病7-10天后,大便菌群涂片检查,A组菌群失调发生率低于对照组(B组),差异有统计学意义(P<0.05).干预两周后,A组、B组各类并发症发生率、严重并发症合计发生率差异无统计学意义(P>0.05),A组、B组严重并发症合计发生率低于对照组(P<0.05).三组均未见不良反应,对照组1例死亡.结论 早期肠内营养支持可增进疗效,降低并发症发生风险;肠内免疫微生态营养更有助于控制病情,改善营养状态,还可减少重症肺炎患者肠道菌群紊乱的发生.%Objective To compare and analyze the effect of enteral microecological nutrition and immune enhanced enteral nutrition on the efficacy,stool flora,nutritional status and prognosis of severe pneumonia. Methods From June 2015 to December 2016,96 patients with severe pneumonia were randomly divided into the A group and the B group,48 cases in each group. At the same period,40 patients with gastrointestinal motility disorder or gastro-intestinal intolerance were included in the control group. Before and 1 and 2 weeks after intervention, their curative effect (CRP and D-dimer,FIB,CPIS),fecal flora examination(bowel dysbacteriosis incidence),nutritional status index (PAB,prealbumin,TRF,transferrin),prognosis(postoperative complications and deaths) were compared a-mong the three groups. The adverse reactions in the three groups were observed. Results After 1-2 weeks of inter-vention,their CRP,D-dimer,FIB,and CPIS were lower than those before intervention,and they were lower in the group A than the control group and the group B,and the group B was lower than the control group(P<0.05). The value of PAB was higher in the group A and B than in the control group during the 1-2 weeks,the value of TRF was obviously higher in the group A and B than in the control group during the first week,and the value of PAB was high-er in the group A than in the group B during the second week(P<0.05). 7-10 days after the onset of severe pneu-monia,the incidence of bacterial flora imbalance in the group A was lower than that in the control group and the group B (P<0.05). After two-week intervention, there was no significant difference in the incidence of complica-tions and the total incidence of serious complications between the group A and the group B(P>0.05). The total in-cidence of severe complications in the group A and the group B was lower than that in the control group(P<0.05). There was no adverse reactions in the three groups,and 1 case in the control group died. Conclusion Early enteral nutrition can improve curative effect and reduce the risk of complications. Ecoimmunonutrition is helpful to control the disease,improve the nutritional status,and reduce the incidence of intestinal flora disturbance of severe pneumonia patients.