益生菌联合早期肠内营养对重型颅脑损伤患者临床疗效及肠道免疫水平的影响

Influence of probiotics combined with early enteral nutrition on clinical efficacy and intestinal immune level in patients with severe craniocerebral injury

目的探讨益生菌与早期肠内营养联合使用对重型颅脑损伤患者的临床疗效及肠道免疫功能的影响。方法选取在东南大学医学院附属江阴医院进行诊治的86例重型颅脑损伤患者,随机分为对照组和观察组,每组43例。对照组患者营养支持方案为伤后经鼻胃管持续泵入康全力肠内营养混悬液,观察组则在对照组的基础上加用益生菌,所有患者均治疗2周。对治疗过程中患者并发症发生情况以及治疗后的GOS评分、免疫功能指标进行评价和比较。结果(1)治疗过程中,观察组患者感染、腹胀腹泻、消化道出血、糖代谢紊乱和应激性溃疡的发生率均明显少于对照组,差异有统计学意义(P<0.05);治疗后观察组患者GOS评分明显高于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者血清IgA、IgG、IgM和补体C3、C4以及Th1/Th2水平的改善情况均明显优于同组治疗前,差异有统计学意义(P<0.05),且观察组患者各项指标改善程度明显优于对照组,差异有统计学意义(P<0.05)。结论对重型颅脑损伤患者联合使用益生菌与早期肠内营养,不仅可以明显减少感染、消化道不良反应等并发症的发生、改善预后,而且可以明显提高患者的免疫功能,值得推广。

Objective To discuss the effects of combination of probiotics and early enteral nutrition on clinical efficacy and intestinal immune level in patients with severe craniocerebral injury.Methods 86 patients with severe craniocerebral injury were selected randomly divided into control group or observation group,43 cases in each group.Both groups were given continuous infusion of enteral nutritional suspension,while the observation group was additionally given probiotics;the treatment course was 2 weeks.The incidence of complications during the treatment as well as the GOS score and immune function after treatment were evaluated and compared between the two groups.Results（1）The incidences of infections,abdominal distension,diarrhea,gastrointestinal bleeding,glucose metabolism disorder and stress ulcer in the observation group were significantly lower than those in the control group（P〈0.05）;the GOS score of the observation group was significantly higher than that of the control group（P〈0.05）.（2）After treatment,the immune indexes including IgA,IgG,IgM,complements C3 and C4,and Th1/Th2 in both groups were significantly better（P〈0.05）,with those of the observation group significantly better than those of the control group（P〈0.05）.Conclusion Combined use of probiotics and early enteral nutrition in patients with severe craniocerebral injury can not only reduce the incidence of complications and improve prognosis,but also significantly improve the immune function of patients.