添加合生元早期肠内营养对高血压脑出血术后患者肠道菌群及分泌型IgA的影响

Effect of early enteral nutrition combined with synbiotics agents on normal intestinal flora and SIgA in pa- tients with hypertensive intracerebral hemorrhage

目的观察添加合生元的早期肠内营养对高血压脑出血术后患者肠道主要正常菌群、粪便分泌型IgA （SIgA）和感染性并发症的影响。方法将53例高血压脑出血术后患者随机分为早期肠内营养组（对照组，n=26）和添加合生元的早期肠内营养组（研究组，n=27），对照组于术后24～48 h采用肠内营养制剂（瑞素）开始营养支持；研究组在对照组的基础上，在肠内营养支持前14 d添加合生元制剂（金双歧）。在营养支持前和第4、8、15天分别采集粪便标本，进行肠道主要正常菌群定量分析，采用酶联免疫吸附法测定粪便SIgA。比较研究期间两组患者感染性并发症的差异。结果在肠内营养支持第8 天和第15 天，研究组大肠杆菌（P=0.004,P=0.004）和肠球菌（P=0.032,P=0.048）低于对照组，双歧杆菌（P=0.046,P=0.024）高于对照组；研究期间乳酸杆菌、类杆菌和梭菌组间比较差异均无统计学意义（P均＞0.05）。在肠内营养支持第15 天，研究组粪便SIgA高于对照组（P=0.035 ）。研究组感染率低于对照组（33.33%与46.15%），但差异无统计学意义（P=0.230）。结论与普通早期肠内营养相比，添加合生元的早期肠内营养有利于促进高血压脑出血术后患者肠道菌群失衡的改善，上调肠道局部免疫功能。

ObjectiveTo investigate the effect of early enteral nutrition combined with synbiotics agents on normal intestinal flora, fecal SIgA and infectious complications in patients with hypertensive intracerebral hemorrhage. MethodsFifty-three patients with hypertensive intracerebral hemorrhage were randomly divided into early enteral nutrition group （control group, n=26） and early enteral nutrition combined with synbiotics group （study group, n=27）.The patients in control group started receiving enteral nutrition （RuiSu） within 24 to 48 hours after injury; Patients in study group received a enteral nutritional support which as well as control group, but added synbiotics （Golden Bifid） in the first 14 days of enteral nutritional support . Stool specimens were Collected on day 0, day 4, day 8, day 15 of enteral nutrition support for quantitative analysis of normal intestinal flora and detection of stool SIgA through enzyme-linked immunosorbent assay . The difference of two groups in infectious complications were observed. ResultsOn nutritional support day 8 and day 15, escherichia coli （P=0.004, P=0.004） and enterococci （P=0.032, P=0.048） expression were lower in study group than the control group, bifidobacteria （P=0.046, P=0.024） expression were higher in study group than the control group. During the study period lactobacillus, bacteroides and clostridium were no statistically significant between the two groups （P〉0.05）. Fecal SIgA expression in study group was higher than control group （P=0.035） on nutritional support day15. The incidence of infectious complications in study group was lower than the control group （33.33% vs. 46.15%）, but there was no significant difference （P=0.230）. Conclusioncompared with ordinary enteral nutrition, enteral nutrition combined with synbiotics agents can be effective in improving intestinal flora imbalance and increase intestinal immune function in patients with hypertensive intracerebral hemorrhage.