肠内、外联合营养支持改良方案对老年重症脑卒中患者肠道微生态的影响

The effect of combined enteral and parenteral nutrition support improvement on the intestinal microecology of elderly patients with severe stroke

目的:探讨肠内、外联合营养支持改良方案对老年重症脑卒中患者肠道微生态的影响。方法:回顾性分析2015年5月~2017年5月我院老年病科ICU收治的年龄≥75岁、格拉斯哥昏迷评分(GCS)在3~8分的脑卒中患者100例,按照随机数字法等分为观察组和对照组,对照组根据患者的实际情况决策后选取单纯肠内营养还是单纯肠外营养支持,观察组采用改良肠内外联合营养支持。比较两组患者营养状况、免疫功能以及各种并发症的发生情况。结果:第21天后观察组患者外周血白蛋白、血红蛋白水平,免疫球蛋白Ig A,Ig G,Ig M水平,T细胞亚群CD4,CD4/CD8比率显著高于对照组,差异有统计学意义(P<0.05);观察组患者各种感染及胃肠道并发症发生情况均低于对照组,差异有统计学意义(P<0.05)。结论:改良的肠内外联合营养支持对老年重症脑卒中患者的肠道微生态具有良好的调节作用,能够显著改善患者营养状态和免疫功能,降低并发症发生,值得临床推广。

Objective: To explore the effect of combined enteral and parenteral nutrition support improvement on the intestinal microecology of elderly patients with severe stroke. Methods: A retrospective analysis was made for a total of 100 stroke patients aged ≥75 and with 3-8 in Glasgow coma score( GCS) admitted to the ICU in the Department of Geriatrics of our hospital from May 2015 to May 2017. With random number method,the patients were divided into observation group and control group. According to the actual situation of patients in the control group,it was decided to adopt simple enteral nutrition or simple parenteral nutrition support. The modified combined enteral and parenteral nutritional support was adopted for the observation group. The nutritional status,immune function and the incidence of various complications were compared between the two groups. Results: After 21 days,it was observed that the level of serum albumin and hemoglobin,the level of immunoglobulin Ig A,Ig G and Ig M and the ratio of T cell subgroup CD4 and CD4/CD8 in the observation group were significantly higher than those in the control group,and the differences was statistically significant( P < 0. 05). It was observed that the incidence of various infections and gastrointestinal complications in the observation group was lower than that in the control group,and the differences were statistically significant( P < 0. 05). Conclusion: The modified combined enteral and parenteral nutrition support has a good regulatory effect on the intestinal microecology of elderly patients with severe stroke,which can significantly improve the nutritional status and immune function of patients,reduce the incidence of complications,and is worthy of clinical promotion.