中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2013年
4期
383-386
,共4页
瞿尔力%陈清%邓秀睿%黄育丹%郑靖阳%林锋%林振浪
瞿爾力%陳清%鄧秀睿%黃育丹%鄭靖暘%林鋒%林振浪
구이력%진청%산수예%황육단%정정양%림봉%림진랑
气管插管%机械通气%早期微量喂养%免疫功能%新生儿
氣管插管%機械通氣%早期微量餵養%免疫功能%新生兒
기관삽관%궤계통기%조기미량위양%면역공능%신생인
Intratracheal intubation%Mechanical ventilation%Early minimal nutrition%Immune function%Newborn infant
目的 研究早期微量喂养对气管插管机械通气治疗中的新生儿免疫功能的影响.方法 将81例气管插管机械通气治疗中的新生儿分为早期微量喂养组(40例)和常规喂养组(41例).检测两组患儿外周血T细胞亚群(CD3、CD4、CD8、CD4/CD8)及免疫球蛋白(IgG、IgA、IgM)水平,观察继发感染、达全胃肠道喂养时间及并发症等情况.结果 气管插管机械通气时间＜5d的患儿两组CD3、CD4、CD8、CD4/CD8及免疫球蛋白水平(IgG、IgA、IgM)相比差异无统计学意义(P＞0.05),而气管插管机械通气时间≥5d的患儿中,早期微量喂养组治疗前后的CD3[(37.3±1.6)％,(42.6±2.8)％]、CD4[(29.1±1.7)％,(34.6±2.1)％]、CD4/CD8(17.9±1.8,18.9±1.6)、IgA[(55.42±3.98) mg/L,(129.00±7.76) mg/L]、IgM[(130.29±10.92) mg/L,(317.33±11.64) mg/L]变化明显高于常规喂养组CD3[(38.5±1.9)％,(39.9±1.4)％]、CD4[(30.0±1.7)％,(31.6±1.8)％]、CD4/CD8(1.63±0.09,1.61±0.13)、IgA[(55.30±5.14) mg/L,(114.05±9.69) mg/L]、IgM[(137.70±11.93) mg/L,(304.95±7.78) mg/L] (P ＜0.05).早期微量喂养组继发感染率、达全胃肠道喂养时间、静脉营养时间和住院时间[20％ (8/40)、(8.56±1.78)d、(10.56±1.78)d、(12.63±1.73)d]明显低于常规喂养组[48.78％(20/41)、(10.20±1.65)d、(12.15±1.69)d、(14.15±1.64)d],差异有统计学意义(P＜0.05).早期微量喂养组腹胀、胃潴留发生率[20％ (8/40)、17.5％ (7/40)]和常规喂养组[24.39％ (10/41)、19.51％ (8/41)]比较,差异无统计学意义(P＞0.05).结论 长时间气管插管机械通气下早期微量喂养可以改善和促进新生儿免疫功能的恢复,降低新生儿继发感染率,缩短达全胃肠道喂养、静脉营养和住院时间.
目的 研究早期微量餵養對氣管插管機械通氣治療中的新生兒免疫功能的影響.方法 將81例氣管插管機械通氣治療中的新生兒分為早期微量餵養組(40例)和常規餵養組(41例).檢測兩組患兒外週血T細胞亞群(CD3、CD4、CD8、CD4/CD8)及免疫毬蛋白(IgG、IgA、IgM)水平,觀察繼髮感染、達全胃腸道餵養時間及併髮癥等情況.結果 氣管插管機械通氣時間＜5d的患兒兩組CD3、CD4、CD8、CD4/CD8及免疫毬蛋白水平(IgG、IgA、IgM)相比差異無統計學意義(P＞0.05),而氣管插管機械通氣時間≥5d的患兒中,早期微量餵養組治療前後的CD3[(37.3±1.6)％,(42.6±2.8)％]、CD4[(29.1±1.7)％,(34.6±2.1)％]、CD4/CD8(17.9±1.8,18.9±1.6)、IgA[(55.42±3.98) mg/L,(129.00±7.76) mg/L]、IgM[(130.29±10.92) mg/L,(317.33±11.64) mg/L]變化明顯高于常規餵養組CD3[(38.5±1.9)％,(39.9±1.4)％]、CD4[(30.0±1.7)％,(31.6±1.8)％]、CD4/CD8(1.63±0.09,1.61±0.13)、IgA[(55.30±5.14) mg/L,(114.05±9.69) mg/L]、IgM[(137.70±11.93) mg/L,(304.95±7.78) mg/L] (P ＜0.05).早期微量餵養組繼髮感染率、達全胃腸道餵養時間、靜脈營養時間和住院時間[20％ (8/40)、(8.56±1.78)d、(10.56±1.78)d、(12.63±1.73)d]明顯低于常規餵養組[48.78％(20/41)、(10.20±1.65)d、(12.15±1.69)d、(14.15±1.64)d],差異有統計學意義(P＜0.05).早期微量餵養組腹脹、胃潴留髮生率[20％ (8/40)、17.5％ (7/40)]和常規餵養組[24.39％ (10/41)、19.51％ (8/41)]比較,差異無統計學意義(P＞0.05).結論 長時間氣管插管機械通氣下早期微量餵養可以改善和促進新生兒免疫功能的恢複,降低新生兒繼髮感染率,縮短達全胃腸道餵養、靜脈營養和住院時間.
목적 연구조기미량위양대기관삽관궤계통기치료중적신생인면역공능적영향.방법 장81례기관삽관궤계통기치료중적신생인분위조기미량위양조(40례)화상규위양조(41례).검측량조환인외주혈T세포아군(CD3、CD4、CD8、CD4/CD8)급면역구단백(IgG、IgA、IgM)수평,관찰계발감염、체전위장도위양시간급병발증등정황.결과 기관삽관궤계통기시간＜5d적환인량조CD3、CD4、CD8、CD4/CD8급면역구단백수평(IgG、IgA、IgM)상비차이무통계학의의(P＞0.05),이기관삽관궤계통기시간≥5d적환인중,조기미량위양조치료전후적CD3[(37.3±1.6)％,(42.6±2.8)％]、CD4[(29.1±1.7)％,(34.6±2.1)％]、CD4/CD8(17.9±1.8,18.9±1.6)、IgA[(55.42±3.98) mg/L,(129.00±7.76) mg/L]、IgM[(130.29±10.92) mg/L,(317.33±11.64) mg/L]변화명현고우상규위양조CD3[(38.5±1.9)％,(39.9±1.4)％]、CD4[(30.0±1.7)％,(31.6±1.8)％]、CD4/CD8(1.63±0.09,1.61±0.13)、IgA[(55.30±5.14) mg/L,(114.05±9.69) mg/L]、IgM[(137.70±11.93) mg/L,(304.95±7.78) mg/L] (P ＜0.05).조기미량위양조계발감염솔、체전위장도위양시간、정맥영양시간화주원시간[20％ (8/40)、(8.56±1.78)d、(10.56±1.78)d、(12.63±1.73)d]명현저우상규위양조[48.78％(20/41)、(10.20±1.65)d、(12.15±1.69)d、(14.15±1.64)d],차이유통계학의의(P＜0.05).조기미량위양조복창、위저류발생솔[20％ (8/40)、17.5％ (7/40)]화상규위양조[24.39％ (10/41)、19.51％ (8/41)]비교,차이무통계학의의(P＞0.05).결론 장시간기관삽관궤계통기하조기미량위양가이개선화촉진신생인면역공능적회복,강저신생인계발감염솔,축단체전위장도위양、정맥영양화주원시간.
Objective To study the effect of minimal enteral nutrition on the immune system of newborn infants under mechanical ventilation (MV) with intratracheal intubation.Methods Eighty-one patients under MV with intratracheal intubation were divided into two groups:treatment group and control group.Forty patients in treatmet group accepted early minimal enteral nutrition,while other 41 patients in control group accepted normal feeding,then T-lymphocytes (CD3,CD4,CD8),CD4/CD8,immunoglobulins (IgG,IgA,IgM),occurane of secondary infection,time of beginning fully enteral feeding,occurance of abdominal distension were recorded.Results There were no significant differences of T-lymphocytes (CD3,CD4,CD8),CD4/CD8,immunoglobulins (IgG,IgA,IgM) changes between the two groups in which the time of patients beginning MV under intratracheal intubation was less than five days (P ＞ 0.05) ; while comparing patients in the two groups whose MV time was equal or greater than five days,the changes of T-lymphocytes CD3[(37.3 ± 1.6)％,(42.6 ±2.8)％],CD4[(29.1 ±1.7)％,(34.6 ±2.1)％],CD4/CD8 (17.9 ±1.8,18.9 ± 1.6),immunoglobulins IgA[(55.42 ±3.98) mg/L,(129.00 ±7.76) mg/L],IgM[(130.29 ±10.92) mg/L,(317.33 ± 11.64) mg/L] in treatment group were more significant than those in control group(P ＜0.05) ;furthermore the differences of the secondary infection occurance,the time beginning fully enteral feeding,intravenous nutrition and hospital stays in the treatment group [20％ (8/40),(8.56 ± 1.78) d,(10.56 ± 1.78) d,(12.63 ± 1.73) d] were lower significantly than those in the control group [48.78％ (20/41),(10.20 ± 1.65) d,(12.15 ± 1.69) d,(14.15 ± 1.64) d] (P ＜ 0.05).These were no significant differences on abdominal distension and gastric retention between the treatment group [20％ (8/40),17.5％ (7/40)]and the control group [24.39％ (10/41),19.51％ (8/41)] (P ＞ 0.05).Conclusion Early minimal enteral nutrition in infants under long time MV with intratracheal intubation could improve immune function recovery,reduce the occurance rate of secondary infection,shorten the time beginning fully enteral feeding,intravenous nutrition and hospital stay.
