早期肠内营养与延迟肠内营养支持对重症肺炎合并心力衰竭患者血清营养指标及预后的影响OA
Effects of Early Enteral Nutrition Support versus Delayed Enteral Nutrition on Serum Nutritional Markers and Prognosis in Patients with Severe Pneumonia Complicated with Heart Failure
目的 探讨早期肠内营养与延迟肠内营养支持对重症肺炎合并心力衰竭患者血清营养指标及预后的影响.方法 回顾性选取2023年1月至2025年1月淮安市第一人民医院收治的102例重症肺炎合并心力衰竭患者为研究对象,根据肠内营养支持时机将患者分为早期组(52例)和延迟组(50例).早期组于入住ICU 24～48 h内开始肠内营养支持,延迟组于入住ICU 48 h后开始肠内营养支持.比较两组干预前后血清营养指标[白蛋白(Alb)、前白蛋白(PAB)、转铁蛋白(TF)]、炎症指标[白细胞计数(WBC)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]、心功能指标[左室射血分数(LVEF)、左室收缩末内径(LVESD)]及预后指标[急性生理与慢性健康评估系统Ⅱ(APACHE Ⅱ)评分、序贯器官衰竭评估(SOFA)评分].比较两组ICU转出率和存活率.结果 干预后,两组Alb、PAB、TF水平均升高(P<0.05),且早期组高于延迟组(P<0.05).干预后,两组WBC、IL-6、TNF-α水平均降低(P<0.05),且早期组均低于延迟组(P<0.05).干预后,两组LVEF均升高(P<0.05),且早期组高于延迟组(P<0.05),两组LVESD均降低(P<0.05),且早期组低于延迟组(P<0.05).干预后,两组APACHE Ⅱ评分、SOFA评分均降低(P<0.05),且早期组均低于延迟组(P<0.05).早期组ICU转出率和存活率高于延迟组(P<0.05).结论 与延迟肠内营养支持比较,早期肠内营养支持对重症肺炎合并心力衰竭患者营养指标的改善效果更佳,对炎症的控制和心功能的改善效果更明显,可获得更佳的预后效果.
Objective To investigate the influence of early enteral nutrition support and delayed enteral nutrition support on serum nutritional indexes and prognosis in patients with severe pneumonia complicated with heart failure.Methods A total of 102 patients with severe pneumonia complicated with heart failure who were treated in Huai'an First People's Hospital from January 2023 to January 2025 were categorized into early group(n=52)and delayed group(n=50)according to the timing of enteral nutrition support.The early group began enteral nutrition support within 24-48 h of ICU admission,whereas the delayed group began enteral nutrition support after 48 h of ICU admission.Serum nutritional indexes[albumin(Alb),prealbumin(PAB),transferrin(TF)],inflammatory indexes[white blood cell(WBC)count,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD)]and prognosis indexes[acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,sequential organ failure assessment(SOFA)score]before and after intervention,as well as ICU discharge rate and survival rate were compared between the two groups.Results After intervention,Alb,PAB and TF levels were increased in both groups(P<0.05),and the above levels in the early group were higher than those in the delayed group(P<0.05).The WBC,IL-6 and TNF-α levels in both groups were decreased after intervention(P<0.05),and the levels were lower in the early group than those in the delayed group(P<0.05).After intervention,LVEF was increased in the two groups(P<0.05),with the early group showing a higher LVEF than the delayed group(P<0.05).LVESD was reduced in both groups(P<0.05),with a lower LVESD in the early group(P<0.05).After intervention,both groups showed reduced APACHE Ⅱ score and SOFA score(P<0.05),with the early group exhibiting lower scores compared to the delayed group(P<0.05).The early group had higher ICU discharge rate and survival rate than the delayed group(P<0.05).Conclusion Compared with delayed enteral nutrition support,early enteral nutrition support has a better improvement effect on nutritional indexes and a more significant effect on controlling inflammation and improving cardiac function in patients with severe pneumonia complicated with heart failure,and it can achieve a better prognosis.
蒋波;张蒙;汤慧敏;徐莉;丁艳;尹力;张东亚
淮安市第一人民医院呼吸与危重症医学科,江苏 淮安 223300淮安市第一人民医院呼吸与危重症医学科,江苏 淮安 223300淮安市第一人民医院呼吸与危重症医学科,江苏 淮安 223300淮安市第一人民医院呼吸与危重症医学科,江苏 淮安 223300淮安市第一人民医院呼吸与危重症医学科,江苏 淮安 223300淮安市第一人民医院呼吸与危重症医学科,江苏 淮安 223300淮安市第一人民医院呼吸与危重症医学科,江苏 淮安 223300
重症肺炎心力衰竭肠内营养支持营养状况预后
severe pneumoniaheart failureenteral nutrition supportnutritional statusprognosis
《转化医学杂志》 2026 (6)
951-955,5
江苏省卫生健康委员会医学科研面上项目(H2024155)
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