免疫营养对脑出血患者免疫功能及预后影响的研究

The Study of Immune Nutrition on the Immune Function and Prognosis with Intracerebral Hemorrhage Patients

目的:探讨免疫营养素谷氨酰胺对脑出血患者免疫功能及预后的影响。方法:将脑出血患者按随机数字表法随机分为普通营养组和免疫营养组,两组患者均采用常规肠内营养(由公式计算全天能量,保证等氮等热量营养),免疫营养组在常规营养基础上添加谷氨酰胺[0.5g/(kg·d)],其他实施常规治疗、护理。在营养支持前及营养支持第7天和第14天三个时间点采集空腹静脉血,分别测定总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)等营养指标、T淋巴细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)等免疫指标,并评估患者GCS评分变化情况。结果:营养支持第14天,免疫营养组的TP、ALB、PA营养指标高于普通营养组,差异有统计学意义(P<0.05),两组患者的三角肌皮褶厚度差异无统计学意义(P>0.05);营养支持第7、14天,免疫营养组CD3^+、CD4^+、CD8^+、CD4^+/CD8^+高于普通营养组,差异有统计学意义(P<0.05);营养支持第14天,免疫营养组的GCS评分高于普通营养组,差异有统计学意义(P<0.05)。结论:添加谷氨酰胺的免疫营养,不但可以改善脑出血患者的营养状况,还可以提高脑出血患者的免疫能力,并促进患者意识好转,以改善脑出血患者的预后。

Objective： Clinical study on the effects of glutamine in intracerebral hemorrhage patients on nutritional in- dicators and prognosis. Methods： Intracerebral hemorrhage patients were randomly divided into general nutrition group and immune nutrition group by random digits table. Both groups were treated with routine enteral nutrition（daily ener- gy supply was calculated by a formula, the same amount off energy and nitrogen ）, the immune nutrition group was add- ed glutamine[0. 5g/（kg·d）]. Collected the fasting blood sample before nutrition support and the seventh, fourteenth day early in the morning, then measured indicators including total serum protein （TP）, albumin （ALB）, prealbumin （PA）, T lymphocyte subsets （CD3＋ , CD4＋ , CD8＋ , CD4＋/CD8＋ ）, judged the GCS score of intraeerebral hemorrhage patients. Results： On nutrition support for 14 days, compared the immune nutrition group, the nutritional status of gen eral nutrition group were more worsen （P〈0. 05） ;deltoid skinfold of two groups were no statistical difference significance（P〈0. 05）;on nutrition support for 7 and 14 days, the change of lymphocyte count in immune nutrition group were more obvious than general nutrition group （P〈0. 05）. On nutrition support for 14 days, compared to general nu- trition group,the GCS score of immune nutrition group were higher than general nutrition group（P〈0. 05）. Conclu sion： Olutamine added immune nutrition can improved the nutritional status and immunity ability of intracerebral hemorrhage patients;promoted consciousness of patients to turn for the better,in order to improve the prognosis of intrace rebral hemorrhage patients.