黄芪匀浆膳对重型颅脑损伤患者免疫功能和营养代谢的影响

Effect of Astragalus-supplemented Homogenized Diet on Immune Function and Nutritional Metabolism in Patients with Severe Brain Injury

目的研究黄芪匀浆膳对重型颅脑损伤患者免疫功能及营养代谢的影响。方法将75例患者依不同营养措施综合考虑各非处理因素分为黄芪匀浆膳组、匀浆膳组和肠内营养多聚合剂组,每组25例。黄芪匀浆膳组尽早(48～72小时)给予改良匀浆膳加黄芪水煎液(相当于生药60g)治疗,匀浆膳组仅给予改良匀浆膳治疗,肠内营养多聚合剂组给予肠内营养多聚合剂治疗,早期肠内营养不足部分由肠外营养补充,共20天。各组肠内营养支持前后均采血测定IgA、IgG、IgM,T细胞亚群(CD4、CD8、CD4/CD8),同时监测空腹血糖、白蛋白、转铁蛋白、血红蛋白、氮平衡等营养代谢指标。结果黄芪匀浆膳组营养支持后IgG、CD4(%)、CD4/CD8升高,与匀浆膳组和肠内营养多聚合剂组比较,差异具有显著性(P<0.01);黄芪匀浆膳组和匀浆膳组营养支持后空腹血糖降低,与肠内营养多聚合剂组比较,差异具有显著性(P<0.01,P<0.05),黄芪匀浆膳组与匀浆膳组比较,差异亦有显著性(P<0.05);黄芪匀浆膳组营养支持后,负氮平衡转为正氮平衡,转铁蛋白与白蛋白升高,与匀浆膳组和肠内营养多聚合剂组比较,差异具有显著性(P<0.05,P<0.01)。结论黄芪匀浆膳可显著改善重型颅脑损伤患者免疫功能、血糖及蛋白质营养代谢。

Objective To study the effect of Astragalus-supplemented homogenized diet on immune function and nutritional metabolism in patients with severe brain injury. Methods Totally 75 patients with severe brain injury were divided into three groups according to their nutrition support methods： Astragalus-supplemented homogenized diet group, homogenized diet group, and enteral nutritional polymers group. Astragalus-supplemented group was treated with homogenized diet and radix Astragalus （ equivalent to 60 g crude drug）, while homogenized diet group was treated with homogenized diet and enteral nutritional polymers group was treated with enteral nutritional polymers. All the three groups were given with nutrition support of 126 kJ/（ kg · d） for 20 days. Venous blood from cubital vein was collected before and after treatment to detect IgA, IgG, IgM, T-lymphocyte subsets, fasting blood glucose, serum albumin, transferrin, and nitrogen balance were measured during enteral nutrition support. Results Compared with the other two groups, IgG, CD4 （ % ）, CD4/CD8 in the Astraga- lus-supplemented group significantly increased （ P 〈 0. 01 ）, fasting blood glucose significantly decreased （ P 〈 0. 01, P 〈 0. 05 ）, and the levels of serum albumin and transferrin significantly increased （P 〈 0. 05, P 〈 0. 01 ）.The nitrogen balance also became positive in the Astragalus-supplemented homogenized diet group. Conclusion Astragalus-supplemented homogenized diet can improve immune function, blood glucose, and protein metabolism in patients with severe brain injury.