肠内增强免疫营养对重症肺炎患者免疫功能及预后的影响

目的 探讨肠内增强免疫营养对重症肺炎患者免疫功能及预后的影响并分析疗效。方法 选择2016年3月至2017年12月我院收治的100例重症肺炎患者，依据抽签法分为两组，其中研究组50例，常规组50例。研究组患者在常规治疗基础上给予免疫增强型肠内营养制剂，对照组患者在常规治疗基础上给予普通肠内营养制剂。比较两组患者干预后粪便菌群变化，干预前后免疫功能和凝血功能的变化，并记录两组患者干预后的并发症发生率和死亡人数。结果 研究组患者菌群失调发生率为4.00%（2/50），低于常规组的20.00%（10/50）(P0.05）。干预治疗1周和2周后，两组患者CD3+细胞、CD4+细胞、CD4+/CD8+、IgA、IgM和IgG水平均上升，CD8+细胞、FIB和D-二聚体水平均降低，且研究组CD3+细胞、CD4+细胞、CD4+/CD8+、IgA、IgM和IgG水平均高于常规组，CD8+、FIB和D-二聚体水平均低于常规组（P<0.05）。研究组患者并发症总发生率为10.00%（5/50），低于常规组（P<0.05）。对照组有1例死亡，研究组未出现死亡。结论 肠内免疫增强营养支持可提高患者疗效，改善患者免疫功能和凝血功能，减少并发症发生，提高患者预后。

Effect of enhanced enteral immunonutrition on immune function and prognosis in patients with severe pneumonia

Abstract: Objective To explore and analyze the effect of enhanced enteral immunonutrition on the immune function and prognosis of patients with severe pneumonia. Methods 100 patients with severe pneumonia treated in our hospital from March 2016 to December 2017 were selected and divided into the observation group or control group based on the lottery method, with 50 patients in each group. The patients in the observation group were treated with enhanced enteral immunonutrition preparations while those in the control group were treated with normal enteral nutrition preparations. The changes of fecal flora after intervention, immune and coagulation functions before and after intervention, and the incidence of complications and deaths after intervention in both groups were recorded. Results The incidence of dysbacteriosis in the observation group was 4.00% (2/50), lower than the 20.00% (10/50) in the control group (P<0.05). Before the intervention, there was no significant differences in immune and coagulation functions between the two groups (P>0.05). After 1 and 2 weeks of intervention, the levels of CD3+cells, CD4+cells, CD4+/CD8+, IgA, IgM and IgG increased while those of CD8+ cells, FIB and D-dimer decreased in both groups; The levels of CD3+cells, CD4+cells, CD4+/CD8+, IgA, IgM and IgG were higher, while those of CD8+, FIB and D-dimer were lower in the observation group than those in the control group, respectively (Ps<0.05). The overall incidence of complications in the observation group was 10.00% (5/50), lower than that in the control group (P<0.05). One death occurred in the control group vs none in the observation group. Conclusion Intestinal enhanced immunonutritional support can improve the efficacy, increase immune and coagulation functions, reduce complications, and improve the prognosis of patients.