目的 观察不同早期肠内营养(EEN)策略对脓毒症合并急性肾功能衰竭(ARF)行连续性肾脏替代治疗(CRRT)患者营养状态及免疫功能的影响.方法 选择2016年6月-2017年6月同济大学附属杨浦医院EICU收治脓毒症合并ARF行CRRT患者61例作为研究对象,根据EEN能量比例的不同分为低能量组(n=30)和高能量组(n=31),均于入院后48 h内采用EEN,低能量组为能全力[(肠内营养混悬液(TPF) ]:康全力[肠内营养混悬液(TPF-DM) ] =1:2,高能量组为能全力:康全力=2:1.治疗1、7 d后,比较2组患者治疗前后营养状态、免疫功能及预后情况.结果 治疗后7 d,2组Alb、PA及Hb水平均较治疗前升高,而低能量组优于高能量组[(38.43 ± 4.52)g/L vs. (35.82 ± 3.85)g/L、(207.81 ± 41.54)mg/L vs. (180.56 ± 47.33)mg/L、(119.32 ± 18.32) g/L vs. (113.07 ± 14.32)g/L,t=2.430、2.380、2.290,P=0.018、0.020、0.039];治疗后7 d,低能量组CD4 +、CD4 +/CD8 +和IgA、IgG、IgM水平均高于治疗前,且优于高能量组[(42.21 ± 5.14)% vs. (40.15 ± 6.32)%、(1.63 ± 0.29)% vs. (1.48 ± 0.30)%、(3.26 ± 0.32)g/L vs. (3.07 ± 0.44)g/L、(16.73 ± 2.42)g/L vs. (14.83 ± 2.24)g/L、(2.61 ± 0.35)g/L vs. (2.36 ± 0.23)g/L,t=2.440、2.490、2.460、2.880、3.110,P=0.046、0.041、0.043、0.038、0.027];与高能量组比较,低能量组ICU住院时间、CRRT时间、机械通气时间均明显缩短[(6.32 ± 1.71)d vs. (7.48 ± 2.24)d、(4.70 ± 1.24)d vs. (5.94 ± 2.52)d、(3.65 ± 1.27)d vs. (5.18 ± 1.81)d],APACHEⅡ评分也明显降低[(12.36 ± 2.35)分 vs. (13.83 ± 3.26)分],差异均有统计学意义(t=2.270、2.420、3.810,2.010,P=0.027、0.018,<0.001、0.049).结论脓毒症合并ARF行CRRT患者给予相对低能量的EEN可最大限度改善患者的营养状态,增强免疫功能.%Objective To explore the influence of different early enteral nutrition(EEN) strategy on the nutrition sta-tus and immune function in sepsis patients with acute renal failure undergoing continuous renal replacement therapy(CRRT). Methods Sxity-one sepsis patients with ARF undergoing CRRT who received treatment in the ICU of our hospital from June 2016 to June 2017 were randomly divided into two groups, including 30 cases of low energy group,31 cases of high energy group. All the patients were given with EEN before 48 h of admission. The proportion of Nengquanli and Kangquanli was 1:2 and 2:1,respectively. The nutrition indicators,immune function and prognosis were compared between two groups. Results After treatment for 7 days,the level of Alb, PA and Hb were significantly elevated in both groups, and low energy group was superior to high energy group[(38.43 ± 4.52) vs. (35.82 ± 3.85)]g/L,[(207.81 ± 41.54) vs. (180.56 ± 47.33)] mg/L,[(119.32 ± 18.32) vs. (113.07 ± 14.32)]g/L(t=2.43,t=2.38,t=2.29,P=0.018,P=0.020,P=0.039);After treatment for 7 days,the level of CD4 +,CD4 +/CD8 +and IgA,IgG,IgM in low energy group were significantly higher than that of before treatment,and was superior to high energy group [(42.21 ± 5.14) vs. (40.15 ± 6.32)]%,[(1.63 ± 0.29) vs. (1.48 ± 0.30)],[(3.26 ± 0.32) vs. (3.07 ± 0.44)]g/L,[(16.73 ± 2.42) vs. (14.83 ± 2.24)]g/L, [(2.61 ± 0.35) vs. (2.36 ± 0.23)]g/L (t=2.44, t=2.49, t=2.46, t=2.88, t=3.11,P=0.046, P=0.041, P=0.043,P=0.038,P=0.027). Compared with high energy group,low energy group had shorter length of ICU stay[(6.32 ±1.71) vs. (7.48 ± 2.24)]d, CRRT time[(4.70 ± 1.24) vs. (5.94 ± 2.52)]d, mechanical ventilation time[(3.65 ± 1.27) vs. (5.18 ± 1.81)]d,APACHEⅡ score[(12.36 ± 2.35) vs. (13.83 ± 3.26)]was also significantly reduced (t=2.27,t=0.027,t=2.42,t=3.81, t=2.01, P=0.018, P<0.001, P=0.049). Conclusion EEN with relative low energy for sepsis patients with ARF undergoing CRRT can improve the nutritional status, and enhance immune function with maximum limit.
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