内科

目的观察免疫营养支持治疗对早期脓毒症患者内皮细胞功能及预后的影响。方法选取早期脓毒症患者99例，随机分为对照组(51例)和实验组(48例)。对照组患者予以常规综合治疗及营养支持治疗，实验组患者在对照组治疗的基础上加用ω-3脂肪酸和谷氨酰胺进行免疫营养支持治疗。治疗前及治疗后7 d、28 d，对两组患者的慢性健康状况进行评价(APACHEⅡ)；检测比较两组患者白蛋白、前白蛋白、可溶性血栓调节蛋白（sTM）、可溶性E选择素（sE选择素）、血管性假性血友病因子(vwF)、内皮素1（ET-1）水平；比较两组患者28 d内感染性休克及严重脓毒症的发生率及病死率。结果治疗28 d后，实验组患者存活38例，对照组患者存活37例。治疗前、治疗后7 d、28 d，两组患者的白蛋白、前白蛋白、降钙素原水平及APACHEⅡ评分比较差异均有统计学意义（P＜0.05），两种治疗方法对患者的白蛋白、前白蛋白、降钙素原水平及APACHEⅡ评分的影响存在差异，治疗方法与治疗时间存在交互作用；两组患者的sTM、sE选择素、vwF、ET-1水平比较差异均有统计学意义（P＜0.01），两种治疗方法对患者的sTM、sE选择素、vwF、ET-1水平的影响存在差异，治疗方法与治疗时间存在交互作用。实验组患者的感染性休克或严重脓毒症的发生率和病死率略高于对照组，但差异无统计学意义（P＞0.05）。结论免疫营养支持治疗可有效改善早期脓毒症患者的血管内皮细胞功能，纠正患者的不良营养状态，有效缓解病情，但其对患者预后的影响尚有待进一步观察。

ObjectiveTo observe the effect of immunonutrition support therapy on endothelial cell function and prognosis in patients with early sepsis. Methods99 patients with early sepsis were randomly divided into control group (51 cases) and experimental group (48 cases). Patients in the control group were treated with conventional comprehensive treatment and nutritional support. The patients in the experimental group were treated with omega-3 fatty acids and glutamine for immunonutrition support treatment based on the control group. The chronic health status of the two groups was evaluated before and after 7 days and 4 weeks of treatment (APACHE II). The total protein, albumin, prealbumin, soluble thrombomodulin (sTM), soluble E-selectin (sE selectin), von Willebrand factor (vwF), and endothelin 1 were compared between the two groups. ET-1) level. The incidence and mortality of septic shock and severe sepsis were compared between the two groups within 4 weeks. ResultsAfter 28 days treatment,there were 38 patients survived in experimental group and 37 patients survived in control group.Before and 7,28 days after treatment, there were significant differences in albumin, prealbumin, procalcitonin levels and APACHE II scores between the two groups (P＜0.05).The effects of the two treatments on the levels of albumin, prealbumin, procalcitonin levels and APACHE II scores were statistic different, and there was an interaction between treatment and time.There were significant differences in levels of sTM, sE selectin, vwF and ET-1 between the two groups (P＜0.01)，the effects of the two treatments on the levels of sTM, sE selectin, vwF, and ET-1 were statistic different, and there was an interaction between treatment and time.The incidence and fatality rate of septic shock or severe sepsis in experimental group were a little bit higher than those in control group,but there were no significant differences (P＞0.05). ConclusionImmunonutrition support treatment can effectively improve the vascular endothelial cell function in patients with early sepsis, correct the patient′s adverse nutritional status, and effectively alleviate the disease, but its impact on the prognosis of patients remains to be further observed.However, its impact on the prognosis of patients remains to be further observed.