探讨早期肠内营养对重型颅脑损伤患者免疫功能及并发症的影响

Change of the immune function and complications in severe brain injury patients after early enternal nutrition supporting

目的探讨重型颅脑损伤患者早期实施肠内营养支持免疫功能及并发症的变化。方法对168例重型颅脑损伤患者(格拉斯哥昏迷评分≤8分)随机分为肠内营养组(EN组,采用十二指肠置管进行早期肠内营养)84例和肠外营养组(PN组)84例。用免疫组织化学法测定两组患者在入院后10d血清中IgG、IgA、IgM及IgE含量及淋巴细胞亚群CD4+、CD_8^+、CD_4^+/CD_8^+值,对比研究两组的免疫功能变化。结果重型颅脑损伤后患者免疫功能明显下降,而EN组患者血清中的IgG、IgA和IgM显著高于PN组(P<0.05);CD_4^+水平及CD_4^+/CD_8^+比值明显高于PN组(P<0.05);IgE明显低于PN组(P<0.05)。结论重型颅脑损伤患者可导致机体免疫功能下降,早期肠内营养支持可提高人体免疫功能,减少并发症。

【Objective】To investigate the changes of the immune function and complications in severe brain injury patients after early enternal nutrition supporting. 【Methods】168 patients with severe brain injury （GCS≤8） were divided randomly into two groups. 84 patients were given early enternal nutrition （EN） by duodenal catheter as EN group, 84 patienes with severe brain injury （GCS≤8） were treated with parenteral nutrition （PN） as PN group. IgG, IgA, IgM, IgE and the T lymphocyte subsets CD4^＋, CD8^＋, CD4^＋/CD8^＋ were detected by immunohistochemical method after them hospitalized 10 days. 【Results】The IgG, IgA, IgM and CD4^＋, CD4^＋/CD8^＋ were higher in EN group than in PN group, the IgE in EN group was less than in PN group, and the complications were less than in PN group （P〈0.05）.【Conclusions】The immunological function of patient with severe brain injury is decreased. Early EN in the severe brain injury patients by duodenal catheter may comprehend the immue function and decrease complications.