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目的:观察早期免疫型肠内营养治疗全身炎症反应综合征的临床疗效、血清炎症细胞因子及免疫球蛋白水平的变化。方法:选择我院重症医学科(ICU)全身炎症反应综合征患者70例,按随机数字表法分为对照组(34例)和试验组(36例)。两组一般治疗措施相同,对照组给予常规肠内营养,试验组在常规营养支持基础上每日添加生理需要量的鱼油、谷氨酰胺及精氨酸。两组均治疗7 d。两组于治疗前后行急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)和SIRS评分,检测C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-1、IL-6I、L-8)、免疫球蛋白(Ig G、Ig A、Ig M)水平。结果:两组治疗前APACHEⅡ、SIRS评分,CRP、TNF-α、IL-1、IL-6I、L-8、Ig G、Ig A、Ig M水平比较,差异无统计学意义(均P>0.05)。与对照组比较,试验组治疗后APACHEⅡ、SIRS评分,CRP、TNF-α、IL-1、IL-6、IL-8下降更为显著(均P<0.05);Ig G、Ig A、Ig M显著增高(均P<0.05)。结论:早期免疫型肠内营养能提高患者免疫功能,减轻全身炎症反应程度,促进患者康复。
Objective: To observe the clinical efficacy of early-type immune enteral nutrition in treating systemic inflammatory response syndrome and the changes of serum inflammatory cytokines and immunoglobulin levels. Methods: Seventy patients with systemic inflammatory response syndrome in intensive care unit (ICU) were randomly divided into control group (34 cases) and experimental group (36 cases). The two groups of general treatment measures the same, the control group given conventional enteral nutrition, the experimental group on a daily basis based on conventional nutritional support to add physiological requirements of fish oil, glutamine and arginine. Both groups were treated for 7 days. The acute physiology and chronic health status score system Ⅱ (APACHEⅡ) and the SIRS score were used to measure the levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-1 -6I, L-8), immunoglobulin (Ig G, Ig A, Ig M) levels. Results: There was no significant difference in APACHEⅡ, SIRS score, CRP, TNF-α, IL-1, IL-6I, L-8, IgG, IgA and IgM before treatment ). Compared with the control group, APACHEⅡ, SIRS score, CRP, TNF-α, IL-1, IL-6 and IL-8 in the experimental group decreased more significantly (all P <0.05) Significantly higher (all P <0.05). Conclusion: Early immune-type enteral nutrition can improve immune function, reduce the degree of systemic inflammatory response, and promote patient rehabilitation.