中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2014年
7期
676-679
,共4页
腹腔感染%肠内营养%益生菌%谷氨酰胺%胰岛素抵抗%感染并发症
腹腔感染%腸內營養%益生菌%穀氨酰胺%胰島素牴抗%感染併髮癥
복강감염%장내영양%익생균%곡안선알%이도소저항%감염병발증
Abdominal infection%Enteral nutrition%Probiotics%Glutamine%Insulin resistance%Infectious complication
目的 探讨由益生菌、谷氨酰氨、深海鱼油和能全力组成的免疫微生态肠内营养对腹腔感染患者术后免疫状态和胰岛素抵抗以及感染并发症发生率的影响.方法 前瞻性纳入2010年9月至2013年4月山东省聊城市人民医院普通外科收治的96例上消化道穿孔患者,按信封法分为治疗组(48例,免疫微生态肠内营养)和对照组(48例,普通肠内营养).分别于术前、术后第3和第7天检测两组患者空腹血糖、空腹胰岛素、对数化胰岛素抵抗指数(lnHOMA-IR)、降钙素原、T细胞亚群水平(CD3+、CD4+、CD8+、CD4+/CD8+)及自然杀伤(NK)细胞计数并进行比较,观察对比两组患者术后感染并发症发生情况.结果 术前和术后第3天,两组患者免疫指标及胰岛素抵抗相关指标的比较,差异均无统计学意义(均P＞0.05).术后第7天,治疗组CD4+、CD4+/CD8+和NK细胞水平均明显高于对照组[(39.1±4.3)％比(30.1±5.7)％,P=0.043;1.76±0.21比1.36±0.12,P=0.038;(19.3±4.8)％比(13.3±3.2)％,P＝0.032];而空腹胰岛素、lnHOMA-IR及降钙素原水平明显低于对照组[(7.3±1.7) mU/L比(10.2±2.1) mU/L,P=0.041;0.60±0.05比0.88±0.06,P=0.039;(0.12±0.07) μg/L比(0.35±0.12)μg/L,P=0.028].治疗组术后感染并发症发生率[18.8％(9/48)]明显低于对照组[39.6％(19/48),P=0.025].结论 对于由上消化道穿孔所致的腹腔感染患者,应用由益生菌、谷氨酰氨、深海鱼油及能全力组成的免疫微生态肠内营养,能改善免疫状态,降低术后胰岛素抵抗,减少术后感染并发症发生率.
目的 探討由益生菌、穀氨酰氨、深海魚油和能全力組成的免疫微生態腸內營養對腹腔感染患者術後免疫狀態和胰島素牴抗以及感染併髮癥髮生率的影響.方法 前瞻性納入2010年9月至2013年4月山東省聊城市人民醫院普通外科收治的96例上消化道穿孔患者,按信封法分為治療組(48例,免疫微生態腸內營養)和對照組(48例,普通腸內營養).分彆于術前、術後第3和第7天檢測兩組患者空腹血糖、空腹胰島素、對數化胰島素牴抗指數(lnHOMA-IR)、降鈣素原、T細胞亞群水平(CD3+、CD4+、CD8+、CD4+/CD8+)及自然殺傷(NK)細胞計數併進行比較,觀察對比兩組患者術後感染併髮癥髮生情況.結果 術前和術後第3天,兩組患者免疫指標及胰島素牴抗相關指標的比較,差異均無統計學意義(均P＞0.05).術後第7天,治療組CD4+、CD4+/CD8+和NK細胞水平均明顯高于對照組[(39.1±4.3)％比(30.1±5.7)％,P=0.043;1.76±0.21比1.36±0.12,P=0.038;(19.3±4.8)％比(13.3±3.2)％,P＝0.032];而空腹胰島素、lnHOMA-IR及降鈣素原水平明顯低于對照組[(7.3±1.7) mU/L比(10.2±2.1) mU/L,P=0.041;0.60±0.05比0.88±0.06,P=0.039;(0.12±0.07) μg/L比(0.35±0.12)μg/L,P=0.028].治療組術後感染併髮癥髮生率[18.8％(9/48)]明顯低于對照組[39.6％(19/48),P=0.025].結論 對于由上消化道穿孔所緻的腹腔感染患者,應用由益生菌、穀氨酰氨、深海魚油及能全力組成的免疫微生態腸內營養,能改善免疫狀態,降低術後胰島素牴抗,減少術後感染併髮癥髮生率.
목적 탐토유익생균、곡안선안、심해어유화능전력조성적면역미생태장내영양대복강감염환자술후면역상태화이도소저항이급감염병발증발생솔적영향.방법 전첨성납입2010년9월지2013년4월산동성료성시인민의원보통외과수치적96례상소화도천공환자,안신봉법분위치료조(48례,면역미생태장내영양)화대조조(48례,보통장내영양).분별우술전、술후제3화제7천검측량조환자공복혈당、공복이도소、대수화이도소저항지수(lnHOMA-IR)、강개소원、T세포아군수평(CD3+、CD4+、CD8+、CD4+/CD8+)급자연살상(NK)세포계수병진행비교,관찰대비량조환자술후감염병발증발생정황.결과 술전화술후제3천,량조환자면역지표급이도소저항상관지표적비교,차이균무통계학의의(균P＞0.05).술후제7천,치료조CD4+、CD4+/CD8+화NK세포수평균명현고우대조조[(39.1±4.3)％비(30.1±5.7)％,P=0.043;1.76±0.21비1.36±0.12,P=0.038;(19.3±4.8)％비(13.3±3.2)％,P＝0.032];이공복이도소、lnHOMA-IR급강개소원수평명현저우대조조[(7.3±1.7) mU/L비(10.2±2.1) mU/L,P=0.041;0.60±0.05비0.88±0.06,P=0.039;(0.12±0.07) μg/L비(0.35±0.12)μg/L,P=0.028].치료조술후감염병발증발생솔[18.8％(9/48)]명현저우대조조[39.6％(19/48),P=0.025].결론 대우유상소화도천공소치적복강감염환자,응용유익생균、곡안선안、심해어유급능전력조성적면역미생태장내영양,능개선면역상태,강저술후이도소저항,감소술후감염병발증발생솔.
Objective To investigate the effect of microbial immune enteral nutrition composed of probiotics,deep sea fish oil,glutamine and nutrison on postoperative immune status,insulin resistance and infectious complication morbidity in patients with abdominal infection.Methods From September 2010 to April 2013 in Shandong Liaocheng City Hospital,96 patients with upper gastrointestinal perforation were prospectively randomized into the treatment group (microbial immune enteral nutrition,n=48) and the control group(conventional enteral nutrition,n=48).Number of T cell subsets (CD3+,CD4+,CD8+,CD4+/CD8+) and natural killer (NK) cell,procalcitonin (PCT),fasting blood glucose (FBG),fasting insulin (FINS),insulin resistance index (InHOMA-IR) calculated by the homeostasis model assessment (HOMA) were detected before operation and on days 3 and 7 after operation and compared between the two groups.The incidence of postoperative infectious complication was collected and compared as well.Results There were no significant differences in immune indexes and insulin resistance-associated indexes between the two groups before operation and on the day 3 after operation (all P＞0.05).On postoperative day 7,CD4+,CD4+/CD8+ and NK cells in treatment group were significantly higher than those in control group [(39.1±4.3)％ vs.(30.1±5.7)％,P=0.043; 1.76± 0.21 vs.1.36±0.12,P=0.038; (19.3±4.8)％ vs.(13.3±3.2)％,P=0.032],while FINS,lnHOMA-IR and PCT in treatment group were significantly lower than those in control group [(7.3±1.7) mU/L vs.(10.2±2.1) mU/L,P=0.041 ; 0.60±0.05 vs.0.88±0.06,P=0.039; (0.12±0.07) μg/L vs.(0.35± 0.12) μg/L,P=0.028].Postoperative infectious complication morbidity was significantly lower in treatment group as compared to control group [18.8％ (9/48) vs.39.6％ (19/48),P=0.025].Conclusion Microbial immune enteral nutrition composed of probiotics,deep sea fish oil,glutamine and nutrison can improve the immune status,decrease the level of insulin resistance,and reduce the incidence of postoperative infectious complication for patients with abdominal infection due to upper gastrointestinal perforation.
