免疫微生态肠内营养方案可改善重症急性胰腺炎患者肠道菌群和预后

李易晨.免疫微生态肠内营养方案可改善重症急性胰腺炎患者肠道菌群和预后[J].内科急危重症杂志,2023,29(1):26-29

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DOI：10.11768/nkjwzzzz20230107

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作者	单位	E-mail
李易晨	深圳市人民医院	1072295304@qq.com

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中文摘要:

摘要目的：研究免疫增强型（IE）与免疫微生态（IM）肠内营养方案对重症急性胰腺炎（SAP）患者肠道菌群及预后的影响。方法：选择86例符合早期肠内营养支持的SAP患者病例资料，采用数字表随机法分为IE组（43例）和IM组（43例），均给予相同的基础治疗和对症支持治疗，在此基础上IE组给予免疫增强型肠内营养方案，IM组给予免疫微生态肠内营养方案。治疗前、治疗7d后取粪便标本检测并比较2组肠道菌群变化；进行急性生理学与慢性健康状况评估（APACHE）Ⅱ、Ranson及Balthazar CT评分，比较2组预后；记录2组患者并发症发生情况。结果：2组治疗7d后双歧杆菌均较治疗前明显增加，IM组乳杆菌较治疗前明显增加，肠杆菌数量明显减少（P均＜0.05）。治疗7d后IM组双歧杆菌、乳杆菌数量明显高于IE组，肠球菌、肠杆菌数量均低于IE组（P均＜0.05）。2组均无死亡病例，2组治疗7d后Balthazar CT评分差异无统计学意义(P＞0.05)。IM组住院时间短于IE组，住院费用低于IE组（P均＜0.05）。IM组感染发生率明显低于IE组（16.28% vs 27.91%，P<0.05）。2组肠内营养不耐受、多器官功能障碍综合征（MODS）、急性呼吸窘迫综合征（ARDS）、胰腺囊肿发生率比较，差异无统计学意义(P均＞0.05)。结论：SAP患者早期应用免疫微生态肠内营养方案在改善肠道菌群和预后、降低感染方面均优于免疫增强型肠内营养方案。

英文摘要:

Abstract Objective: To investigate the effects of immunoenhanced (IE) and immunomicroecology (IM) enteral nutrition regimen on intestinal flora and prognosis of patients with severe acute pancreatitis (SAP). Method: A total of 86 SAP patients eligible for early enteral nutrition support were randomly divided into IE group (43 cases) and IM group (43 cases) by a digital table method. Both groups were given the same basic treatment and symptom-specific supportive treatment. On this basis, IE group was given immune-enhanced enteral nutrition program, and IM group was given immune-microecological enteral nutrition program. Fecal samples were collected before and 7 days after treatment and the changes of intestinal flora in the two groups were compared. Acute physiology and chronic health status assessment (APACHE) Ⅱ, Ranson and Balthazar CT scores were performed to compare the prognosis of the two groups. Complications were recorded in the two groups. Results: After 7 days of treatment, the number of bifidobacterium in 2 groups was significantly increased, that of lactobacillus in IM group was significantly increased, and that of Enterobacterium in IM group was significantly decreased as compared with those before treatment (all P< 0.05). The number of enterobacter in IM group was significantly less than that before treatment, and the difference was statistically significant (P< 0.05). After 7 days of treatment, the number of bifidobacterium and Lactobacillus in IM group was significantly larger than that in IE group, while the number of enterococcus and Enterobacter in IM group was less than that in IE group (P< 0.05). There were no deaths in the two groups, and there was no significant difference in Balthazar CT score between the two groups after 7 days of treatment (P> 0.05). The hospital stay in IM group was shorter than that in IE group, and the hospitalization cost was lower than that in IE group (P< 0.05). The incidence of infection in IM group was significantly lower than that in IE group (16.28% vs 27.91%,P< 0.05). There was no significant difference in the incidence of enteral feeding intolerance, multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS) and pancreatic cyst between 2 groups (P> 0.05). Conclusion: Early application of IM enteral nutrition program in SAP patients is not superior to IE enteral nutrition program in improving intestinal flora, improving prognosis and reducing infection.