不同肠内营养液对老年重度AECOPD机械通气患者肠道屏障功能、免疫功能和炎症因子的影响

摘要 目的：探讨不同肠内营养液对老年重度慢性阻塞性肺疾病急性加重期（AECOPD）机械通气患者营养状况、肠道屏障功能、免疫功能和炎症因子的影响。方法：纳入2019年10月-2021年10月在我院住院治疗的老年重度AECOPD患者90例作为研究对象，采用密封信封法随机分为含膳食纤维肠内营养组（FEN组）及不含膳食纤维肠内营养组（NFEN组）各45例。两组患者均接受重度AECOPD规范治疗，并接受机械通气治疗。FEN组给予能全力进行营养支持治疗，NFEN组给予能全素进行营养支持治疗，两组患者均接受持续30 d的肠内营养。比较两组患者治疗前和治疗30 d后营养状况指标血清白蛋白（ALB）、前白蛋白（PA）、血红蛋白（Hb），肠道屏障功能指标D-乳酸（DLA）、细菌内毒素（BE）、二胺氧化酶（DAO），T淋巴细胞亚群（CD4⁺、CD8⁺、CD4⁺/CD8⁺）、体液免疫功能指标免疫球蛋白（Ig）G、IgM、IgA，炎症因子降钙素原（PCT）和白介素-6（IL-6）水平的变化，以及两组患者ICU住院天数、机械通气时间和并发症的差异。结果：治疗30 d后，FEN组ALB、PA和Hb水平均显著高于NFEN组（P<0.05）；FEN组DLA、BE和DAO水平均显著低于NFEN组（P<0.05）；FEN组CD4⁺、CD4⁺/CD8⁺以及IgG、IgA水平均显著高于NFEN组（P<0.05）；FEN组PCT、IL-6水平均显著低于NFEN组（P<0.05）。FEN组患者ICU住院天数、机械通气时间及并发症均显著少于NFEN组，差异有统计学意义（P<0.05）。结论：含膳食纤维肠内营养有利于改善老年重度AECOPD机械通气患者营养状况，修复肠道黏膜屏障功能，提高免疫功能，减轻炎症反应，从而改善预后，含膳食纤维的肠内营养支持治疗效果更佳。

Effects of Different Enteral Nutrition Solutions on Intestinal Barrier Function, Immune Function and Inflammatory Factors in Elderly Patients with Severe AECOPD Undergoing Mechanical Ventilation

ABSTRACT Objective: To investigate the effects of different enteral nutrition solutions on nutritional status, intestinal barrier function, immune function and inflammatory factors in elderly patients with severe chronic obstructive pulmonary disease in severe exacerbation (AECOPD). Methods: 90 elderly patients with severe AECOPD hospitalized in our hospital from October 2019 to October 2021 were included as the research object. They were randomly divided into dietary fiber enteral nutrition group (FEN group) and non dietary fiber enteral nutrition group (NFEN group) by sealed envelope method, 45 cases each. Both groups received standard treatment for severe AECOPD and mechanical ventilation. FEN group was given full nutrition support treatment, NFEN group was given full nutrition support treatment, and both groups received enteral nutrition for 30 days. The nutritional status indexes serum albumin (ALB), prealbumin (PA), hemoglobin (HB), intestinal barrier function indexes D-lactic acid (DLA), bacterial endotoxin (BE), diamine oxidase (DAO), T lymphocyte subsets (CD4⁺, CD8⁺, CD4⁺/ CD8⁺), humoral immune function indexes immunoglobulin (Ig) g, IgM and IgA were compared between the two groups before and 30 d after treatment, The changes of inflammatory factors procalcitonin(PCT) and interleukin-6(IL-6), as well as the differences of ICU hospitalization days, mechanical ventilation time and complications were caompared between the two groups. Results: 30 d after treatment, the levels of ALB, PA and Hb in FEN group were significantly higher than those in NFEN group (P<0.05). The levels of DLA, BE and DAO in FEN group were significantly lower than those in NFEN group (P<0.05). The levels of CD4⁺, CD4⁺/CD8⁺, IgG and IgA in FEN group were significantly higher than those in NFEN group (P<0.05). PCT and IL-6 levels in FEN group were significantly lower than those in NFEN group (P<0.05). The ICU length of stay, mechanical ventilation time and complications in Fen group were significantly less than those in nfen group (P<0.05). Conclusion: Enteral nutrition with dietary fiber is helpful to improve the nutritional status of elderly patients with severe AECOPD, repair the intestinal mucosal barrier function, improve immune function, reduce inflammatory reaction, so as to improve the prognosis. Enteral nutrition with dietary fiber has a better therapeutic effect.