Comparison of effects of different enteral nutritional agents on nutritional status and intestinal mucosal barrier in patients with septic shock / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the effects of different early enteral nutrient (EN) emulsions of TPF-T and TP on nutritional status and intestinal mucosal barrier in patients with septic shock. Methods From May 2017 to May 2018, 112 patients with septic shock were continuously enrolled in the Department of Intensive Care Unit of the First People's Hospital of Taizhou, and they were randomly divided into a TPF-T group and TP group, each group with 56 cases. After admission, the patients in both groups were all treated according to the 2016 Saving Sepsis Campaign (SSC) Guidelines for septic shock. Both groups were supported with EN, TPT-T group was given TPF-T EN emulsion rich in fish oil, while TP group was supported with standard TP EN emulsion, and the therapeutic course was consecutive 7 days in both groups. The differences in nutritional status, inflammatory response, immune function, intestinal mucosal barrier, gastrointestinal symptoms and prognosis were compared between the two groups. Results After EN, the nutrition indicators such as albumin (Alb), prealbumin (PA), transferrin (TRF) and immune indexes (IgA, IgG), human leukocyte DR antigens (HLA-DR) and D-lactic acid were increased in both groups, reaching the peaks on the 7th day after EN application, Alb, PA, TRF, IgA, IgG, HLA-DR in the TPF-T group were significantly higher than those in the TP group [Alb (g/L) 34.43±5.81 vs. 33.59±5.34, PA (mg/L) 269.83±47.56 vs. 252.67±41.92, TRF (g/L) 3.43±0.64 vs. 3.32±0.81, IgA (mg/L) 159.45±34.56 vs. 143.31±33.81, IgG (mg/L) 4 947.68±871.66 vs. 4 583.75±841.54, HLA-DR (68.22±9.11)% vs. (62.21±9.69)%], and after EN, the D-lactic acid in the TPF-T group was significantly lower than that in the TP group (mg/L 30.42±6.79 vs. 33.34±7.31). The inflammatory indicators of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), procalcitonin (PCT), endotoxin and diamine oxidase (DAO) were all gradually reduced in two groups, reached the lowest levels on the 7th day after EN application, and all the above-mentioned indicators in the TPF-T group were significantly lower than those in the TP group [TNF-α (ng/L)95.43±20.69 vs. 109.59±23.45, CRP (mg/L) 21.33±16.35 vs. 32.36±17.83, PCT (μg/L) 1.24±1.21 vs. 4.18±1.32, endotoxin (U/L) 10.32±2.31 vs. 11.54±2.69, DAO (g/L) 19.45±8.49 vs. 25.47±9.41]. The incidences of gastric retention, diarrhea and paralysis of lower digestive tract in TPF-T group were significantly lower than those in TP group [gastric retention 14.29% (8/56) vs. 32.14% (18/56), diarrhea 12.50% (7/56) vs. 35.71% (20/56), paralysis of lower digestive tract 7.14% (4/56) vs. 23.21% (13/56)], the length of hospital stay was significantly shorter in the TPF-T group than that in the TP group (days 18.77±5.08 vs. 21.71±6.67, P < 0.05); however, there was no significant difference in mortality between the two groups [14.29% (8/56) vs. 21.43% (12/56), P > 0.05]. Conclusion TPF-T could more effectively maintain nutritional status, reduce inflammatory reaction, improve immunity, protect intestinal mucosal barrier function, and has fewer adverse reactions, which was helpful to improve the prognosis of septic shock patients.