早期肠内营养对重型颅脑损伤患者外周血C-反应蛋白水平变化的影响

Influence of early enteral nutrition on blood CRP contents in patients after severe craniocerebral injury

目的将肠内营养早期实施于重型颅脑损伤患者,通过相关急性时相反应蛋白CRP在体液中的微观改变,探讨肠内营养保护肠道黏膜、减轻全身炎症反应的作用。方法神经外科30例重型颅脑损伤患者,分为早期肠内营养（EEN）组和早期胃肠外营养（PN）组,入院48 h内给予不同方法的营养支持,测定伤后当天、第1天、第4天、第7天、第14天血浆中CRP的含量。结果不同时间重型颅脑损伤患者血浆CRP水平发生变化。随时间变化两组CRP浓度均呈下降趋势,但EEN组下降幅度明显。伤后第4天EEN组血浆CRP含量低于PN组（P〈0.05）,具有统计学意义。伤后第7天、第14天EEN组同时相段血浆CRP含量明显低于PN组（P〈0.01）。EEN组伤后第14天GCS评分高于PN组（P〈0.05）。结论重型颅脑损伤后早期行肠内营养治疗,可起到保护胃肠道黏膜、降低全身炎症反应的作用。如果胃肠道功能允许,首先应考虑早期采用肠内营养。

Objective To study how enteral nutrition protects intestinal tract mucous membrane and reduces the whole body inflammatory response through observing microscopic change of related acute phase response protein CRP in the body fluid when enteral nutrition is used in early time in patients with severe craniocerebral injury. Methods Thirty patients with severe craniocerebral injury （ GCS 〈 8 ） including 23 severer patients （ GCS6 - 8 ） and 7 the severest patients （ GCS3 - 5 ）, which were randomly divided into two groups as early enteral nutrition （EEN） group （15 cases） and early parenteral nutrition （PN） group （15 cases）. Thirty patients were in neurosurgery department in the past year and were given different nutritional support within 48 hours after admission. The serum CRP concentration of all patients were determined on days 0,1,4,7 and 14 after injury, respectively. Results The patients＇ blood plasma CRP levels changed with time in craniocerebral injury patient. The CRP densities in the two group tended to drop, but that in the EEN group declined obviously,significantly lower than that in the PN group （ P 〈0.05） on the 4th day after injury. The CRP contents in the EEN group were very significantly lower than that in the PN group （ P 〈 0.01 ） on the 7th day and 14th day after injury. The CRP walin of in EEN group was higher than that on the PN group （P 〈 0.05） in the 14th day after inyury by GCS grading. Con- clusions After severe craniocerebral injury, enteral nutrition support in early time may play a role in protecting gastrointestinal tract mucous membrane and reducing the whole body inflammatory response. If the gastrointestinal tract function allows, enteral nutrition should be considered first.