目的 探讨免疫营养素强化的肠内营养治疗对创伤危重患者免疫功能及临床结局的影响.方法 选择2015年4月至2016年12月青海省人民医院骨科收治的创伤危重患者82例作为研究对象,采用随机数字法将患者随机分为观察组和对照组,每组41例.对照组采用常规肠内营养联合肠外营养辅助支持;观察组在对照组基础上加用免疫营养素强化的肠内营养支持治疗(使用“海能博”大元素组件谷氨酰胺、精氨酸组件和膳食纤维补充剂组件);均连续治疗14 d以上.所有患者均在营养支持治疗前及治疗第7天和第14天检测免疫学指标[外周血CD4+、CD8+、CD4/CD8+、血清免疫球蛋白(Ig)A、IgG、IgM]和营养学指标(血清总蛋白、前白蛋白、白蛋白),并记录临床结局指标,包括胃肠道症状、感染并发症、住院时间等.结果 治疗前2组CD4+、CD8+、CD8+/CD4+、IgA、IgG、IgM、总蛋白、前白蛋白、白蛋白、血红蛋白水平比较差异均无统计学意义(均P ＞0.05).治疗第7天和第14天,观察组细胞免疫指标CD4+、CD8+、CD4+/CD8+及体液免疫指标IgA、IgG、IgM水平均明显高于对照组;观察组总蛋白、前白蛋白、白蛋白、血红蛋白水平均明显高于对照组,差异均有统计学意义(均P＜0.05).2组均无死亡病例.观察组便秘发生率明显低于对照组[9.8％ (4/41)比26.8％ (11/41)] (P =0.004),余胃肠道症状发生率2组间差异无统计学意义(P＞0.05).观察组感染并发症发生率明显低于对照组[7.3％ (3/41)比34.1％ (14/41)] (P =0.003).观察组住院时间明显短于对照组[(18±4)d比(24±5)d](P＜0.001).结论 免疫营养素强化的肠内营养支持治疗可以改善创伤危重患者的营养状态和免疫功能,并能促进胃肠蠕动,改善胃肠功能.%Objective To investigate the effect of enteral nutrition enriched with immune-modulating nutrients on immune function and clinical outcomes of critical injured patients.Methods Eighty-two critical injured patients admitted from April 2015 to December 2016 in Qinghai Provincial People's Hospital were randomly divided into observation group and control group,with 41 cases in each group.The control group had routine enteral nutrition plus parenteral nutrition;the observation group had enteral nutrition enriched with immune-modulating nutrients(" Hainengbo" glutamine + arginine + dietary fiber) on the basis of control group;both groups were treated for at least 14 d.Immunological indexes[peripheral blood CD4+,CD8+,CD4+/CD8+,serum immunoglobulin (Ig)A,IgG,IgM] and nutriological indexes(serum total protein,prealbumin,albumin) were tested before and on the 7th,14th day after treatment.Clinical outcome indicators including incidences of gastrointestinal reaction,infection and length of hospital stay were recorded.Results There were no significant differences of CD4+,CD8+,CD4+/CD8+,IgA,IgG,IgM,total protein,prealbumin and albumin between groups before treatment(P ＞ 0.05).On the 7th and 14th day after treatment,CD4+,CD8+,CD4+/CD8+,IgA,IgG,IgM in observation group were significantly higher than those in control group (P ＜ 0.05);total protein,prealbumin and albumin in observation group were significantly higher than those in control group (P ＜ 0.05).No death occurred in both groups.Incidence of constipation in observation group was significantly lower than that in control group[9.8％ (4/41) vs 26.8％ (11/41)] (P =0.004).Incidences of other gastrointestinal reactions had no significant differences between groups(P ＞ 0.05).Infection rate in observation group was significantly lower than that in control group [7.3％ (3/41) vs 34.1％ (14/41)] (P =0.003).Length of hospital stay in observation group was significantly shorter than that in control group[(18 ±4)d vs (24 ±5)d] (P ＜0.001).Conclusion Enteral nutrition enriched with immune-modulating nutrients treating critical injured patients can improve nutritional state,immune function and gastrointestinal function.
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