CAJ | 학술논문

目的：探讨精氨酸、ω－3多不饱和脂肪酸强化的肠内营养对感染性休克患者炎症反应和免疫功能的调节作用及其可能的机制。方法收集2011－01～2014－12入住本院ICU并确诊为感染性休克的患者，共67例患者纳入研究。病例随机分为对照组和干预组，干预组36例，其中男21例，女15例，年龄21～80岁，平均年龄（62．53±13．29）岁；对照组31例，其中男17例，女14例，年龄38～78岁，平均年龄（59．13±14．43）岁。入住后第2天开始给予等热量、等氮量肠内营养制剂2周。干预组采用含精氨酸及ω－3多不饱和脂肪酸强化的肠内营养剂Impact，对照组使用普通的肠内营养剂Milupa GmbH。疗效评估方法：分别于治疗前、治疗后第7天及第14天测定炎症因子CRP、PCT动态变化；检查血浆总蛋白、白蛋白及前白蛋白水平；测定免疫相关指标淋巴细胞比例、CD4、CD8、CD4／CD8以及HLA－DR的动态变化情况；分别于入院时和治疗后第14天采用APACHEⅡ评分标准对两组患者进行评估。结果干预组及对照组的年龄、性别构成、原发病构成以及入院时血清乳酸水平和APACHEⅡ评分差异无统计学意义。①两组患者CRP、PCT水平均明显下降，且干预组较对照组更为明显；②两组患者淋巴细胞比例、CD4、CD8、CD4／CD8以及HLA－DR均明显升高，且干预组较对照组更为明显；③接受治疗后两组患者在营养状态方面都有改善，两组患者比较差异无统计学意义；④与治疗前比较，两组患者APACHEⅡ评分均降低；但治疗第7天后，干预组APACHEⅡ评分较对照组降低更为明显。结论精氨酸及ω－3多不饱和脂肪酸强化的肠内营养能减缓感染性休克患者的急性炎症反应，改善其免疫功能。
목적：탐토정안산、ω－3다불포화지방산강화적장내영양대감염성휴극환자염증반응화면역공능적조절작용급기가능적궤제。방법수집2011－01～2014－12입주본원ICU병학진위감염성휴극적환자，공67례환자납입연구。병례수궤분위대조조화간예조，간예조36례，기중남21례，녀15례，년령21～80세，평균년령（62．53±13．29）세；대조조31례，기중남17례，녀14례，년령38～78세，평균년령（59．13±14．43）세。입주후제2천개시급여등열량、등담량장내영양제제2주。간예조채용함정안산급ω－3다불포화지방산강화적장내영양제Impact，대조조사용보통적장내영양제Milupa GmbH。료효평고방법：분별우치료전、치료후제7천급제14천측정염증인자CRP、PCT동태변화；검사혈장총단백、백단백급전백단백수평；측정면역상관지표림파세포비례、CD4、CD8、CD4／CD8이급HLA－DR적동태변화정황；분별우입원시화치료후제14천채용APACHEⅡ평분표준대량조환자진행평고。결과간예조급대조조적년령、성별구성、원발병구성이급입원시혈청유산수평화APACHEⅡ평분차이무통계학의의。①량조환자CRP、PCT수평균명현하강，차간예조교대조조경위명현；②량조환자림파세포비례、CD4、CD8、CD4／CD8이급HLA－DR균명현승고，차간예조교대조조경위명현；③접수치료후량조환자재영양상태방면도유개선，량조환자비교차이무통계학의의；④여치료전비교，량조환자APACHEⅡ평분균강저；단치료제7천후，간예조APACHEⅡ평분교대조조강저경위명현。결론정안산급ω－3다불포화지방산강화적장내영양능감완감염성휴극환자적급성염증반응，개선기면역공능。
Obej ctive To investigate the effect of immune -enhanced enteral nutrition supplemented with arginine and ω-3polyunsaturated fatty acid on the host immune and inflammatory responses in patients with septic shock .Methods Sixty-seven patients with septic shock from January 2011 to December 2014 were divided into two groups:intervention group and control group .Intervention group included 21 males and 15 females with an average age of 62.53 ±13.29 (range, 21 to 80), and control group included 17 males and 14 females with an average age of 59.13 ±14.43 ( range, 38 to 78).Intervention group was given enriched arginine and ω-3 polyunsaturated fatty acid enteral nutrition: Impact, while the control group was only given isocaloric standard enteral diet: Milupa GmbH.Enteral nutrition was started within 24 hours after admission via naso -jejunum tube and continued for 14 days.The inflammatory responses ( CRP and PCT ) , immune index including the continue change of percentage of lymphocyte , CD4, CD8, CD4/CD8, HLA -DR and the levels of serum protein before and on the 7 th and 14 th day after therapy were measured .The APACHEⅡscores were evaluated on the first day and 14 days after therapy .Results There were no significant differences of age, gender, primary disease and the scores of APACHEⅡ between two groups before received therapy.①On the 7th and 14th day after the treatment, the inflammatory responses were decreased insignificantly in both groups , and the intervention group decreased more apparently .②With the development of treatment , the percentage of lymphocyte CD 4, CD8, CD4/CD8 and HLA -DR were increased in both groups .The immune index of intervention group improved more apparently .③There were significant difference between two groups in improving nutritional status .④Compared to pre -therapy, the APACHEⅡscores of two groups , which were evaluated on the 7th day after therapy, were decreased , while the therapy group decreased significantly .Conclusion Immune -enhanced enteral nutrition supplemented with arginine and ω-3 polyunsaturated fatty acid would control inflammatory response and improve the immune function of patients with septic shock .