早期肠内免疫微生态营养在重症肺炎治疗中的应用观察

目的研究早期肠内免疫微生态营养对重症肺炎肠道菌群分布及肠道黏膜屏障的影响,为重症肺炎患者选择可靠的营养支持方式提供依据。方法选取2017年1月至2019年1月在我院接受治疗的82例重症肺炎患者。采用随机数字表法随机分为观察组(n=41)与对照组(n=41)。所有患者入院即采用常规治疗,对照组患者在常规治疗基础上建立全胃肠外营养(TPN),观察组患者给予早期肠内营养(EN)及肠内免疫微生态营养。详细记录两组患者基线资料。记录观察组与对照组干预第0、7、14 d时活菌数的分布情况,分别计算双歧杆菌、粪肠球菌、大肠埃希菌、弯曲杆菌、乳酸杆菌活菌数,并进行组间比较。检测血清内毒素、D-乳酸和二胺氧化酶(DAO)水平。比较两组的预后情况。结果治疗7 d、14 d后,观察组患者的双歧杆菌与乳酸杆菌数量显著高于对照组,而治疗7 d后观察组患者大肠埃希菌数量显著低于对照组,治疗14 d后,观察组患者大肠埃希菌、粪肠球菌、弯曲杆菌数量显著低于对照组,差异具有统计学意义(P<0.05)。治疗第7 d,观察组血清内毒素、D-乳酸和DAO水平低于对照组,差异具有有统计学意义(P<0.05)。观察组弥漫性血管内凝血、呼吸衰竭、心力衰竭、菌血症等严重并发症的发生率低于对照组(P<0.05)。观察组无死亡,对照组1例死亡。结论早期肠内免疫微生态营养能够调节肠道菌群,保护肠道黏膜屏障,促进疾病康复,减少感染和并发症。

Application of early enteral immune microecological nutrition in the treatment of severe pneumonia

Objective To observe the effect of early enteral immune microecological nutrition on intestinal flora distribution and intestinal mucosal barrier in patients with severe pneumonia,and provide evidence for selecting reliable nutritional support for the patients.Methods A total of 82 patients with severe pneumonia who received treatment in our hospital from January 2017 to January 2019 were selected and randomly divided into observation group or control group.All patients were treated with conventional treatment upon admission;additionally,the control group was given total parenteral nutrition(TPN)while the observation group was given early enteral nutrition(EN).Detailed baseline data of patients in both groups were recorded.The distribution and number of live colonies of Bifidobacterium,Enterococcus faecalis,Escherichia coli,Campylobacter and Lactobacillus was recorded on day 0,7 and 14 of the intervention,and compared between groups.The serum levels of endotoxin,D-lactic acid and diamine oxidase(DAO)were detected.The prognoses of the patients were compared between groups.Results Seven days and fourteen days after treatment,the counts of Bifidobacterium and Lactobacillus in the observation group were significantly higher than in the control group;the observation group had lower count of Escherichia coli than the control group 7 days after treatment;and 14 days after treatment,the counts of E.coli,Enterococcus faecalis and Campylobacter in the observation group were significantly lower than those in the control group(P<0.05).At the 7 th day of treatment,the serum levels of endotoxin,D-lactic acid and DAO in the observation group were lower than those in the control group,with statistically significant differences(all P<0.05).The incidence of severe complications such as diffuse intravascular coagulation,respiratory failure,heart failure and bacteremia in the observation group was lower than that in the control group(P<0.05).There were no deaths in the observation group and one in the control group.Conclusion Early enteral immune microecological nutrition can regulate intestinal flora,protect intestinal mucosal barrier,promote the recovery from diseases and reduce infections and complications.