早期肠内营养干预对老年肺部炎性疾病伴营养不良患者的治疗效果

Therapeutic effect of early enteral nutrition for elderly patients with pulmonary inflammatory disease and malnutrition

摘要:

目的 探究早期肠内营养(EEN)干预对老年肺部炎性疾病伴营养不良患者营养及肺功能的影响。方法 选取2017年5月至2018年12月唐山市开滦总医院营养科收治的老年肺部炎性疾病伴营养不良患者96例,按随机数表法分为对照组及研究组,各组48例。对照组仅给予常规饮食干预,研究组在对照组基础上加用EEN干预。观察并比较2组患者治疗前后营养状态[血清总蛋白(TP)、白蛋白(ALB)及血红蛋白(Hb)]、肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及FEV1/FVC]、免疫功能指标(CD3⁺、CD4⁺、CD4⁺/CD8⁺及IgA、IgG、IgM)、炎性指标[白细胞介素-10(IL-10)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)]。采用SPSS 21.0统计软件进行数据分析。组间比较采用独立样本t检验。结果 (1)营养状态。对照组患者TP、Hb及ALB干预前分别为(56.03±2.81)、(28.53±2.85)和(109.74±10.97)g/L,干预后分别为(56.15±2.82)、(28.92±2.89)和(123.86±12.39)g/L；研究组患者TP、Hb及ALB干预前分别为(56.17±2.82)、(28.57±2.86)和(112.96±11.30)g/L,干预后分别为(59.77±2.99)、(32.47±3.25)和(131.07±13.11)g/L。干预前2组患者TP、ALB及Hb比较差异不显著(P>0.05)；干预后,与对照组比较,研究组患者TP、ALB及Hb水平显著升高,差异有统计学意义(P<0.05)。(2)肺功能。对照组患者FEV1、FVC及 FEV1/FVC干预前分别为(1.40±0.14)L、(2.33±0.42)L和(62.11±6.26)%,干预后分别为(1.63±0.18)L、(2.51±0.41)L和(66.93±6.70)%；研究组患者FEV1、FVC及 FEV1/FVC干预前分别为(1.42±0.12)L、(2.41±0.37)L和(62.48±6.31)%,干预后分别为(1.93±0.27)L、(2.79±0.36)L和(72.54±7.23)%。干预前2组患者FEV1、FVC及 FEV1/FVC水平比较差异不显著(P>0.05)；干预后,研究组FVC、FEV1、及FEV1/FVC水平均显著高于对照组(P<0.05)。与干预前比较,干预后2组患者FVC、FEV1及FEV1/FVC水平均显著升高,差异有统计学意义(P<0.05)。(3)免疫指标及炎性指标。干预前,2组患者免疫功能相关指标和炎症指标差异均不显著(P>0.05)。干预后,与对照组比较,研究组患者上述免疫功能相关指标及炎性指标IL-10水平均显著升高,同时IL-6和TNF-α水平显著降低,差异有统计学意义(P＜0.05)。结论 EEN能有效改善老年肺部炎性疾病患者营养状态,提高患者免疫力并减弱其炎症反应,进而提高患者肺功能,具有临床推广意义。

Abstract:

Objective To explore the effect of early enteral nutrition (EEN) intervention on nutrition and pulmonary function in the elderly pulmonary inflammatory disease patients with malnutrition. Methods A total of 96 elderly pulmonary inflammatory disease patients accompanied with malnutrition admitted in the Nutrition Department of our hospital from May 2017 to December 2018 were recruited in this study. They were randomly divided into control group and research group, with 48 cases in each group. The patients of the control group were only given routine dietary intervention, while those of the study group were given EEN on the basis of the control group. Nutritional status [total serum protein (TP), albumin (ALB), hemoglobin (Hb)], pulmonary function [forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC], immune function (percentages of CD3⁺ and CD4⁺ cells, CD4⁺/CD8⁺, and IgA, IgG and IgM levels) and inflammatory indices [interleukin 10 (IL-10), IL-6 and tumor necrosis factor α(TNF-α)] were observed and compared between the 2 groups before and in 14 d after treatment. SPSS statistics 21.0 was used for data analysis. Independent sample t test was employed for comparison between groups. Results (1)Nutritional status. TP, Hb and ALB in control group were increased from (56.03±2.81), (28.53±2.85) and (109.74±10.97)g/L respectively before intervention, to (56.15±2.82), (28.92±2.89) and (123.86±12.39)g/L after intervention. For the research group, the indicators were increased from (56.17±2.82), (28.57±2.86) and (112.96±11.30)g/L respectively to (59.77±2.99), (32.47±3.25) and (131.07±13.11)g/L respectively. There was no significant differences in the levels between the 2 groups before intervention (P>0.05), and the levels were significantly higher in the research group than the control group after intervention (P<0.05). (2)Pulmonary function. FEV1, FVC and FEV1/FVC changed from (1.40±0.14)L, (2.33±0.42)L and (62.11±6.26)% before intervention to (1.63±0.18)L, (2.51±0.41)L and (66.93±6.70)% after intervention in the control group. In the research group, FEV1, FVC and FEV1/FVC were increased from (1.42±0.12)L, (2.41±0.37)L and (62.48±6.31)% to (1.93±0.27)L, (2.79±0.36)L and (72.54±7.23)% respectively. No significant differences was seen in the levels of FEV1, FVC and FEV1/FVC between the 2 groups before intervention (P>0.05), and the levels in the research group were significantly higher than those in the control group after intervention (P<0.05). (3)Immune and inflammatory indices. Before intervention, there were no significant differences in immune function related indices and inflammatory indices between the 2 groups (P>0.05). After intervention, the level of IL-10 was significantly increased, while those of IL-6 and TNF-α were obviously decreased in the research group when compared with the control group (P<0.05). Conclusion EEN intervention effectively improves the nutritional status in the elderly patients with pulmonary inflammatory diseases, improves the immunity and attenuates their inflammatory responses, and improves the cardiopulmonary function. It is worthy of clinical promotion.