摘要
目的探讨早期肠内营养治疗对颅脑损伤患者肠道免疫功能及感染的影响.方法将80例重症监护病房收治的颅脑损伤患者按随机数字表法分为研究组和对照组,每组40例,研究组采用早期肠内营养支持治疗,对照组采用肠外和脑内营养支持序贯治疗,直至能经口进食.两组均于脑内营养治疗第1d、7d、15 d检测血清白细胞介素6、白细胞介素10、白细胞介素17、免疫球蛋白A、免疫球蛋白G、内毒素、C-反应蛋白、降钙素原水平变化,采用血常规仪检测外周血白细胞计数、淋巴细胞计数,记录各组患者治疗期间医院感染发生情况,统计呼吸机使用时间、住院时间、30 d死亡率.结果(1)营养治疗第15 d研究组血清白细胞介素6、白细胞介素10、白细胞介素17、内毒素、C-反应蛋白、降钙素原水平均较营养治疗第1d显著下降(P<0.01),各项指标水平均显著低于对照组(P<0.01);血清免疫球蛋白A、免疫球蛋白G水平均较营养治疗第1d显著升高(P<0.01),各项指标水平均显著高于对照组(P<0.01).(2)营养治疗第7d、15 d两组血清白细胞计数均较营养治疗第1d显著下降(P<0.01),研究组显著低于对照组(P<0.01);两组淋巴细胞计数均较营养治疗第1d显著升高(P<0.01),研究组显著高于对照组(P<0.01).(3)研究组肺部感染发生率(40.0%)显著低于对照组(80.0%)(P<0.01),呼吸机使用时间、重症监护病房住院时间显著短于对照组(P<0.01).结论早期肠内营养治疗有利于恢复机体免疫功能,显著降低炎症反应和感染发生率,缩短住院时间,对重型颅脑损伤患者的治疗和预后具有重要意义.
Objective To investigate the effect of early enteral nutrition on intestinal immune function and infection in patients with craniocerebral injury.Methods 80 patients with craniocerebral injury admitted to intensive care unit were randomly divided into study group and control group with 40 cases in each group.The study group was treated with early enteral nutrition support while the control group was treated with sequential parenteral and enteral nutrition support until they could eat through the mouth.The levels of serum interleukin 6,interleukin 10,interleukin 17,IgA,IgG,endotoxin,C-reactive protein and procalcitonin were detected on the 1st,7th and 15th days of enteral nutrition treatment in both groups.Peripheral blood leukocyte count and lymphocyte count were detected by blood routine analyzer.The incidence of hospital infection during treatment in each group was recorded,and ventilator usage time,hospitalization time and 30-day mortality rate were counted.Results(1)the levels of serum interleukin 6,interleukin 10,interleukin 17,endotoxin,C-reactive protein and calcitonin in the study group on the 15th day of nutrition therapy were significantly lower than those in the control group on the 1st day of nutrition therapy on average(P<0.01),and all indexes in the study group were significantly lower than those in the control group(P<0.01).The levels of serum IgA and IgG were significantly higher than those in the 1st day of nutritional therapy(P<0.01),and the levels in the study group were significantly higher than those in the control group(P<0.01).(2)On the 7th and 15th day of nutrition therapy,the white blood cell count in both groups was significantly lower than that on the 1st day of nutrition therapy(P<0.01),the study group was significantly lower than that in the control group(P<0.01),the lymphocyte count in both groups was significantly higher than that on the 1st day of nutrition therapy(P<0.01),and the study group was significantly higher than that in the control group(P<0.01).(3)The incidence of pulmonary infection in the study group(40.0%)was significantly lower than that in the control group(80.0%)(P<0.01),and the duration of ventilator use and ICU stay were significantly shorter than that in the control group(P<0.01).Conclusions Early enteral nutrition therapy is beneficial to restore the immune function of the body,significantly reduce the incidence of inflammatory reaction and infection,shorten the hospitalization time,and is of great significance to the treatment and prognosis of patients with severe craniocerebral injury.
作者
鲁锐
徐凌玉
于丽丽
Lu Rui;Xu Lingyu;Yu Lili(Jiamusi Central Hospital of Heilongjiang Province,Jiamusi 154000,Heilongjiang,China;不详)
出处
《临床心身疾病杂志》
CAS
2020年第2期133-136,148,共5页
Journal of Clinical Psychosomatic Diseases
关键词
肠内营养
颅脑损伤
免疫功能
感染
Enteral nutrition
craniocerebral injury
immune function
infection