经鼻空肠管行EEN对老年机械通气患者血清MCP-1和免疫功能的影响

摘要

目的 探讨经鼻空肠管行早期肠内营养(EEN)对危重症机械通气老年患者血清MCP-l和免疫功能的影响.方法 2014年2月至2016年2月机械通气老年患者120例,随机分为2组,各60例.对照组全静脉营养,观察组经鼻空肠管进行早期肠内营养.比较两组患者机械通气总时间、入住ICU时间、2周内成功撤机比例和呼吸机相关性肺炎(VAP)发病率;比较不同时间点两组患者血清蛋白、氮平衡和总蛋白水平等营养指标;比较治疗前后血清炎性因子MCP-1和HMGB-1水平及免疫细胞水平.结果 观察组患者机械通气总时间和入住ICU时间均缩短、14d内成功撤机比例提高,且VAP发病率降低;观察组营养后各项营养指标优于对照组、MCP-1和HMGB-1水平均低于对照组;观察组CD4+、CD4+/CD8+均高于对照组、CD8+含量显著低于对照组,差异均有统计学意义(P＜0.05).结论 对机械通气的老年患者采用EEN,有利于提高患者免疫力和营养水平,减少机体炎性反应,缩短患者机械通气时间.%Objective To explore the effects of EEN on serum MCP-1 and immune function in elderly patients with severe mechanical ventilation through nasal cavity.Methods 120 cases of severe ill patients in our hospital from February 2014 to February 2016 were selected and divided into experimental group and control group according to the random number table method.Patients in the control group were given total parenteral nutrition, and the experimental group was given early enteral nutrition through nasal cavity.The total duration of mechanical ventilation and the ICU duration, the rate of successful weaning and the incidence of ventilator-associated pneumonia (VAP) were compared between the two groups.The nutritional indexes of the two groups were compared at different time points.The nutritional indexes mainly included serum protein, nitrogen balance and total protein.The levels of serum inflammatory cytokines MCP-1 and HMGB-1 were compared between the two groups before and after nutrition, and the levels of immune cells were compared between the two groups before and after nutrition.Results The duration of mechanical ventilation and the duration of ICU were significantly shorter in the experimental group (P＜0.05).The proportion of successful weaning in 14 days was significantly improved in the experimental group(P＜0.05) and the incidence of VAP was significantly lower (P＜0.05).The nutritional indexes of the experimental group were significantly better than those of the control group (P＜0.05).The levels of MCP-1 and HMGB-1 in the experimental group were significantly lower than those in the control group (P＜0.05).The levels of CD4+, CD4+ / CD8+ in the experimental group were significantly higher than those in the control group (P＜0.05), while the content of CD8+ was significantly lower than that of the control group (P＜0.05).Conclusion The use of EEN in elderly patients with mechanical ventilation is beneficial to improve the immunity and nutritional level of patients, reduce the body's inflammatory response, shorten the mechanical ventilation time.It is worthy ofclinical promotion.