益生菌联合幽门后喂养对重型颅脑损伤患者营养状况及VAP的研究

Study on effects of probiotics combined with post pyloric feeding on nutritional status and VAP in patients with severe craniocerebral injury

目的观察益生菌联合幽门后喂养对重型颅脑损伤患者营养状况及呼吸机相关性肺炎(VAP)的影响。方法将93例重型颅脑损伤患者随机分为3组,其中A组31例患者行早期胃内喂养法,B组31例患者行早期幽门后喂养法,C组31例患者行益生菌联合早期幽门后喂养法。连续观察营养开始第1、3、5、8、15天血清总蛋白(TP)、血红蛋白、清蛋白(ALB)、前清蛋白(PA)、胆碱酯酶(CHE)、空腹血糖、格拉斯哥昏迷分级(GCS)评分结果,并测定并记录营养开始第1、5、8、15天测量上臂围(AC)、三头肌皮褶厚度(TSF)、上臂肌围(AMC),以评估3组营养状况,统计3周内VAP发生率及反流误吸发生率,于营养开始第1、3、7、14、21天测定3组患者的C-反应蛋白(CRP)、白细胞(WBC)、降钙素原(PCT)等结果,第7、14、21天进行胸部CT检查评估肺部感染。结果营养开始第3、5、8、15天3组TP、PA水平比较差异有统计学意义(P<0.05),营养开始第5、8、15天3组ALB水平、GCS评分比较差异有统计学意义(P<0.05),营养开始第8、15天3组CHE水平、FBG水平比较差异有统计学意义(P<0.05),营养开始第15天3组AC、AMC比较差异有统计学意义(P<0.05),3组3周内VAP发生率与反流误吸发生率比较,差异有统计学意义(P<0.05);营养开始第14、21天3组CRP水平比较差异有统计学意义(P<0.05),营养开始第7、14、21天3组WBC、PCT水平比较差异有统计学意义(P<0.05),营养开始第21天3组肺部感染发生率比较差异有统计学意义(P<0.05),且C组上述测定指标均明显优于A组、B组(P<0.05)。结论益生菌联合幽门后喂养在改善重型颅脑损伤患者营养状况与昏迷程度、控制血糖水平等方面起到积极作用,促使CRP、WBC、PCT等趋于正常范围,降低VAP发生率、反流误吸发生率及肺部感染发生率。

Objective To observe the effects of probiotics combined with post pyloric feeding on the nutritional status and ventilator associated pneumonia(VAP)in the patients with severe craniocerebral injury.Methods Ninety-three patients with severe craniocerebral injury were randomly divided into three groups,31 patients in the group A were given the early gastric feeding,31 patients in the group B were given the early post pyloric feeding,and 31 patients in the group C were given probiotics combined with the early post pyloric feeding.The serum total protein(TP),hemoglobin,albumin(ALB),prealbumin(PA),cholinesterase(CHE),blood glucose level and Glasgow Coma Scale(GCS)score were continuously observed on 1,3,5,8,15 d of nutrition beginning,the upper arm circumference(AC),triceps skin fold thickness(TSF)and upper arm muscle circumference(AMC)were measured and recorded for assessing the nutritional status of the three groups on 1,5,8,15 d of the nutrition beginning,the incidence rates of VAP and reflux aspiration within 3 weeks were counted,C-reactive protein(CRP),white blood cell(WBC)count and procalcitonin(PCT)were measured on 1,3,7,14,21 d after the nutrition beginning,the chest CT examination was performed for assessing pulmonary infection on 7,14,21 d.Results There were statistically significant differences in the levels of TP and PA on 3,5,8,15 d after the nutrition beginning among the three groups(P<0.05),there were the statistically significant differences in the level of ALB and GCS scores on 5,8,15 d after the nutrition beginning among the three groups(P<0.05),there was the statistically significant difference in the levels of CHE and FBG on 8,15 d after the nutrition beginning among the three groups(P<0.05),there was statistically significant difference in AC and AMC on 15 d after the nutrition beginning among the three groups(P<0.05),there was statistically significant differences in the incidence rate of VAP and reflux aspiration within 3 weeks among the three groups(P<0.05),there were the statistically significant differences in the CRP level on 14,21 d after the nutrition beginning among the three groups(P<0.05),there were the statistically significant differences in the levels of WBC and PCT on 7,14,21 d after the nutrition beginning among the three groups(P<0.05),there was the statistically significant difference in the incidence rate of pulmonary infection on 21 d after the nutrition beginning among the three groups(P<0.05),moreover the above measured indexes in the group C were significantly better than those in the group A and B(P<0.05).Conclusion Probiotics combined with post pyloric feeding play an active role in the aspects of improving the nutritional status and coma degree and controlling blood sugar level in the patients with severe craniocerebral injury,promotes the levels of CRP,WBC and PCT to trend to normal range,reduces the incidence rates of VAP,reflux aspiration and pulmonary infection.