中文摘要：

目的探讨早期少量肠内滋养对维护严重创伤患者肠黏膜屏障完整性的价值。方法选取2014年1月1日至2015年3月31日入住相城人民医院重症医学科（ICU）符合纳入标准的严重创伤患者。按照前瞻、随机、对照原则，采用随机数字表法，分为早期少量肠内营养（滋养组）和早期足量肠内营养（对照组）。所有患者入住ICU12～24h内给予百普力肠内营养，入住ICU72h后营养量达到目标营养量[104．6kJ／（kg·d）]的25％为滋养组，达到目标营养量的60％为对照组。比较两组患者不同的喂养不耐受、新发肺部感染、ICU感染的相关并发症、住院时间、ICU医疗费用以及观察患者第1天，第3天，第7天肠黏膜屏障功能指标：尿乳果糖和甘露醇比值（L／M）、血清D-乳酸水平及二胺氧化酶浓度。结果共有56例严重创伤患者纳入本研究。与对照组作比较，滋养组喂养不耐受2例（P=0．012）及新发肺部感染8例（P=0．046），有明显改善，而ICU相关感染的并发症4例（P=0．135）、住院时间（8．82±5．16）d（P=0．126）、总住院时间（15．22±11．27）d（P=0．223）、医疗费用（6．75±3．49）万元（P=0．235）以及肠黏膜屏障功能指标与对照组比较均差异无统计学意义。结论严重创伤患者早期肠内滋养即能改善肠黏膜屏障，达到足量肠内营养治疗效果，并降低新发肺部感染及喂养不耐受发生率。

英文摘要：

Objective To investigate the value of early trophic feeding on maintenance of the integrity of intestinal mucosa barrier in severe traumatic patients. Methods The seriously traumatic patients were eligible for enrollment to this study from January 1st, 2014 to March 31st, 2015 in the intensive care unit of Xiangcheng People＇ s Hospital. All patients were randomly divided into early enteral nutrition （EEN） group and the control group. Within 12 to 24 hours after ICU admission, all patients were fed on enteral nutrition. In the EEN group, the nutrient was reached to 25% of target nutrient amount [ 104.6 kJ/ （ kg · d） ], and in the control group, the nutrition was reached to 60% of the target nutrient amount. Comparisons of feeding intolerance, incidence of newly developed lung infection, the total length of hospital stay, ICU medical costs, and the markers of mucosa barrier function including lactulose/mannitol ratios （L/M）, serum lactic acid level, and diamine oxidase （the first day, the third day and the seventh day） between two groups were carried out. Results Of them, 56 patients were treated with early enteral nutrition. Early enteral feeding intolerance and ICU associated infection complications were significantly lower in EEN group than those in control group （ P = 0. 012, P = 0. 046 ）. There were no significant differences in ICU associated infection complications, the length of ICU stay, the length of hospital stay, ICU medical costs, L/M ratios, D-lactic acid level and diamine oxidase concentration between the two groups （P=0.135, P=0.126, P=0.223, P=0.235）. Conclusions Under the seriously traumatic stress, the significantly increased intestinal mucosal permeability will be occurred early. In patients with early trophic feeding, the intestinal mucous membrane barrier function can be improved, thus decreasing ICU associated infection complications and incidence of feeding intolerance.