不同时期肠内营养对脑卒中后吞咽障碍患者免疫及营养指标影响

Effects of enteral nutrition at different stages on immune and nutritional parameters in patients with dysphagia after stroke

目的研究不同时期肠内营养对脑卒中后吞咽障碍患者免疫及营养指标的影响,为临床治疗提供参考。方法选择该院2015年11月至2017年11月收治的脑卒中后吞咽障碍患者86例作为研究对象,依据实施肠内营养支持的时间不同按照数字随机表法分为两组,每组43例。其中对照组性入院第4d开始鼻饲,试验组入院当天开始鼻饲。对比两组患者治疗2周后营养及免疫功能指标变化。结果治疗2周后,两组患者清蛋白(ALB)、前清蛋白(PA)、血红蛋白(Hb)、急性生理功能和慢性健康状况评分(APACHEⅡ)评分及SOFA评分等营养指标均较治疗前改善明显,且试验组优于对照组,差异有统计学意义(P<0.05)。治疗2周后,两组患者的IgG、IgA、IgM免疫球蛋白水平、中性粒细胞的趋化指数、黏附率、吞噬率、杀菌率、NK细胞数等免疫学指标均较治疗前降低,且试验组优于对照组,差异均有统计学意义(P<0.05)。结论早期肠内营养可有效改善脑卒中后吞咽障碍患者营养状况,提高其机体免疫力,值得在临床上推广。

Objective To study the effect of enteral nutrition on immune and nutritional indexes in patients with dysphagia after stroke,and to provide reference for clinical treatment. Methods 86 patients with dyspha gia after stroke in the hospital from November 2015 to November 2017 were selected as the research objects. According to the different periods of the implementation of enteral nutrition support, the patients were divided into two groups according to the random number table method, 43 cases in each group. The control group be gan to nasal feeding fourth days after admission, and the experimental group began to nasal feeding on the day of admission. Compared two groups of patients after 2 weeks of nutrition and immune function index changes. Results After 2 weeks of treatment, the two groups of patients with albumin （ALB）,prealbumin （PA）,he moglobin （Hb）,APACHEII score and SOFA score and other nutritional indicators were significantly im proved than before treatment, and the experimental group was better than the control group, the difference was statistically significant （P〈0.05）. After 2 weeks of treatment, two groups of patients with IgG,IgA, IgM,immunoglobulin level, neutrophil chemotaxis, adhesion rate, phagocytic rate, sterilization rate, NK cell counts of immunological indexes were lower than those before treatment, and the experimental group was bet ter than the control group, the difference was statistically significant （P〈0.05）. Conclusion Early enteral nutrition can effectively improve the nutritional status of patients with dysphagia after stroke and improve their immunity,which is worthy of clinical promotion.