早期肠内营养联合合生元提高重型颅脑损伤患者的免疫功能

Early Enteral Nutrition Combined with Synbiotics Agents in Enhancing Cellular Immune Function in Patients with Severe Head Injury

目的观察早期肠内营养联合合生元对重型颅脑损伤患者细胞免疫功能和感染性并发症的影响。方法将39例重型颅脑损伤患者按随机数字表法分为对照组(n=19)和观察组(n=20)。对照组患者于伤后24～48h内采用肠内营养制剂(瑞素)营养支持;观察组患者在伤后24～48h内采用肠内营养制剂(瑞素)营养支持的基础上,在肠内营养支持的前14d开始使用了合生元(金双歧)。在肠内营养支持0、4、8、15d分别检测外周血CD3+、CD4+、CD8+、CD4+/CD8+的表达,观察两组患者感染性并发症的差异。结果观察组患者在营养支持8、15d外周血CD3+、CD4+、CD4+/CD8+的表达比对照组高(P<0.01或P<0.05)。观察组患者术后感染性并发症的发生率较对照组有降低趋势(35.0%vs52.6%),但差异无统计学意义(P>0.05)。结论与单纯早期肠内营养相比,早期肠内营养联合合生元更有利于重型颅脑损伤患者细胞免疫功能恢复和降低感染性并发症发生率。

Objective To investigate the effects of early enteral nutrition combined with synbiotics agents on cellular immune function and infectious complications in patients with severe head injury.Methods Thirty-nine patients with severe head injury were randomly divided into early enteral nutrition group（control group,n=19）and early enteral nutrition combined with synbiotics group（observational group,n=20）.The patients in the control group received enteral nutrition（RuiSu）within 24 to 48 h after injury.While the patients in the observational group received an enteral nutritional support based on RuiSu treatment and synbiotics（Golden Bifid）in the first 14 d of enteral nutritional support.The peripheral blood Tlymphocytes CD3^＋,CD4^＋,CD8^＋ and CD4^＋/CD8^＋were detected on 0,4,8,15 d of enteral nutrition support.The difference of infectious complications in two groups was observed.Results With the nutritional support on 8 and 15 d,peripheral blood CD3^＋,CD4^＋,CD4^＋/CD8^＋ expression were higher in observational group than those of the control group（P〈0.01 or P〈0.05）.The incidence of infectious complications in observational group was lower than the control group（35.0% vs 52.63%）,but there was no significant difference（P〈0.05）.Conclusion Compared with ordinary enteral nutrition,enteral nutrition combined with synbiotics agents are more conducive to the recovery of cellular immune function and reduce the incidence of infectious complications in patients with severe head injury.