Effects of early immune enteral nutrition combined with glutamine parenteral nutrition on T-lymphocyte subsets in patients with severe pulmonary infection in intensive care unit / 中国医师进修杂志

ABSTRACT

Objective:To study the effect of early immune enteral nutrition combined with glutamine (Gln) parenteral nutrition on T-lymphocyte subsets in patients with severe pulmonary infection in the intensive care unit (ICU).Methods:A total of 70 ICU patients with severe pulmonary infection who were treated in Yinzhou People′s Hospital from January 2017 to October 2019 were selected, and the patients were divided into enteral nutrition group and combined group according to a completely random method with 35 cases in each group. Both groups of patients were given conventional treatment; patients in the enteral nutrition group was given immunoenhanced enteral nutrition on the basis of conventional treatment, and those in the combined group was given Gln on the basis of enteral nutrition group. The levels of arterial oxygen partial pressure (PaO 2), arterial oxygen saturation (SaO 2), arterial partial pressure of carbon dioxide (PaCO 2), CD 8+, CD 3+, CD 4+/CD 8+, procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP) and tumor necrosis factor alpha (TNF-α) before and after treatment were detected and compared between two groups. The treatment efficacy was compared between two groups too. Results:After treatment, the levels of SaO 2 and PaO 2 in combined group were higher than those in enteral nutrition group, the level of PaCO 2 in combined group was lower than that in enteral nutrition group, but there were no significant differences ( P>0.05). After treatment, the levels of CD 3+, CD 4+/CD 8+ in combined group were higher than those in enteral nutrition group [(62.37 ± 6.15)% vs. (59.35 ± 5.24)%, 1.50 ± 0.18 vs. 1.12 ± 0.11], the level of CD 8+ in combined group was lower than that in enteral nutrition group [(33.15 ± 6.11)% vs. (37.72 ± 8.57)%], and there were significant differences ( P<0.05). The levels of PCT, hs-CRP and TNF-αin combined group were lower than those in enteral nutrition group [(3.83 ± 0.82) μg/L vs. (6.47 ± 1.34) μg/L, (6.92 ± 1.25) mg/L vs. (12.72 ± 3.83) mg/L, (92.35 ± 13.05) ng/L vs. (125.26 ± 18.35) ng/L], and there were significant differences ( P<0.05). The total effective rate in combined group was higher than that in enteral nutrition group [88.57%(31/35) vs. 65.71%(23/35)], and there was significant difference ( χ2=5.185, P<0.05). Conclusions:Early immune enteral nutrition combined with Gln parenteral nutrition has significant effects on patients with severe pulmonary infection in ICU, and can improve the level of T-lymphocyte subsets, control infection, and reduce inflammatory factor levels.