早期肠内营养对重型颅脑损伤患者免疫功能及结局的影响

Influence of early enternal nutrition on the immune function and outcome in patients with severe traumatic brain injury

目的研究早期肠内营养（EEN）对重型颅脑损伤患者免疫功能及结局的影响。方法将2010年3月至2011年3月泰州市人民医院131名重型颅脑损伤患者分为EEN组（n=69）和对照组（n=62），观察伤后（或术后）7d内并发症发生及病死情况。于伤后（或术后）第7天检测体液免疫指标，采用特异性荧光抗体标记、流式细胞仪检测外周血淋巴细胞亚群。结果与对照组比较，EEN组7d内糖代谢紊乱，腹泻、腹胀，各种感染，多器官功能障碍综合征，应激性溃疡等并发症发生率明显较低（P=0．000、P=0．002、P=0．001、P=0．004、P=0．002），住院病死率也明显较低（P=0．028）。EEN组IgM、IgG明显高于对照组（P均=0．000），补体c3、补体C4明显低于对照组（P均=0．000），而IgA差异无统计学意义（P=0．144）。EEN组CD3^＋ CD4^＋、CD4^＋／CD8^＋ 比值、CD19^＋ 明显高于对照组（P均=0．000），CD3^＋ CD8^＋ 差异无统计学意义（P=0．070），CD16^＋ CD56^＋ 明显低于对照组（P=0．026）。结论重型颅脑损伤患者对EEN的耐受性较好，患者的免疫功能和结局得到改善。

Objective To explore the influence of early enteral nutrition （EEN） on the immune function and outcome in patients with severe traumatic brain injury. Methods Totally 131 patients with severe traumatic brain injury who were admitted to the Intensive Care Unit of our hospital between March 2010 and March 2011 were enrolled in this study. Among them, 69 were in EEN group and 62 were in control group. On day 7, humoral immune function was measured using automatic biochemistry analyzer, and the peripheral blood lymphocyte subset proportions were measured using flow cytometry. The complications were recorded in the initial 7 days after trauma. Results Compared with the control group, the EEN group had significantly lower incidences of complications including glucose metabolism disorder, diarrhea/stomach intestine distend, infection, multiple organ dysfunction syndrome, and stress ulcer on day 7 （P =0. 000, 0. 002, 0. 001,0. 004, and 0. 002）. Hospital mortality in the EEN group was also significantly lower than that in control group （ P = 0. 028）. The serum levels of IgM and IgG in EEN group were significantly higher than in control group （ both P = 0. 000 ）, whereas the serum levels of C3 and CA in the EEN group were significantly lower （ both P = 0. 000 ）. IgA showed no significant difference between these two groups （ P = 0. 144 ）. The serum levels of CD3^＋ CD4 ^＋ T lymphocytes, CD4^＋ /CD8^＋ T lymphocytes, and CD19^＋ lymphocytes in the EEN group were significantly higher than in control group （ all P = 0. 000）, while CD3^＋ CD8^＋ T lymphocytes showed no significant difference （P = 0. 070）. The serum level of CD16^＋ CD56^＋ T lymphocytes in the EEN group was significantly lower than that in control group （P = 0. 026）. Conclusion Patients with severe traumatic brain injury have good tolerance of EEN, which may enhance the immune function and improve the outcome of the patients.