早期肠内营养支持治疗对重症脑出血患者免疫功能和预后指标的影响

Effect of early enteral nutrition on immune function and prognostic indicators of the patients with severe intracerebral hemorrhage

目的：探讨早期肠内营养（early enteral nutrition,EEN）治疗对重症脑出血患者免疫功能和预后指标的影响。方法：随机将173例重症脑出血伴吞咽障碍患者分为对照组（n=77）和EEN组（n=96）,入院后12~48 h分别给普通鼻饲饮食和予肠内营养（EN）。两组患者于入院第2和第14天后采用美国国立卫生院神经功能缺损量表（National Institutes of Health Stroke Scale,NIHSS）进行功能评分,并观察两组患者营养指标及免疫球蛋白（Ig A、Ig G、Ig M）,淋巴细胞计数（LYM）和细胞因子CD4＋、CD8＋、CD4＋/CD8＋值,并且比较两组患者预后并发症的发生情况。结果：入院14 d后,EEN组患者NIHSS评分显著低于对照组（P〈0.05）;两组患者入院后第2天各项营养指标无显著差异,第14天对照组TP、Alb、PA和Hb指标较第2天显著降低（P〈0.05）,EEN组患者的TP、Alb、PA和Hb均明显高于对照组,差异具有统计学意义（P〈0.05）;EEN组患者Ig A、Ig M、CD4＋显著升高,LYM和CD4＋/CD8＋升高,Ig G接近术前水平,CD8＋降低;EN组患者并发症低于对照组组,但无统计学差异（P〉0.05）。结论：早期肠内营养支持治疗可以改善重症脑出血患者的神经功能、免疫功能、身体营养状态。

Objective： To investigate the effects of early enteral nutrition （EEN） on immune function and prognostic indicators of the patients with severe intracerebral hemorrhage. Methods- A total of 173 patients of severe intracerebral hemorrhage accompanied with dysphagia were randomly divided into control group （n=77） and EEN group （n=96）. At 12-48 h after admission, the patients in EEN group were given nasogastric enteral nutrition support with enteral nutritional emulsion （TPF） while the patients in control group were treated with general nasal feeding diet. Neurological scores of patients were tested by National Institutes of Health Stroke Scale （NIH Stroke Scale, NIHSS） at 2 and 14 d after admission respectively, and the changes of nutritional indicators and the complications were observed simultaneously. Furthermore, immunoglobulin and T lymphocyte subsets in blood samples from two group patients were detected. Results： At the 14th day, the NIHSS in treatment group were significantly lower than that of the control group （P〈0.05）; There was no significant difference of nutrition indicators between the two groups at the 2nd day, The levels of TP, Alb, PA and Hb in the control group were decreased and lower significantly than those of the EEN group at the 14th day （P〈0.05）. Furthermore, the levels of IgA, IgM, CD4＋, LYM and ratio CD4＋/CD8＋ in the EEN group were significantly higher than those in the control group （all P〈0.05）, the level of CDS＋was crosscurrent. The incidence of complications in the EEN group was lower than that in the control group, but the difference had no statistical significance （P〉0.05）. Conclusion： The treatment of EEN can improve the neurological and immune functions of patient as well as the nutritional status of body.