早期肠内营养联合益生菌在重型颅脑外伤病人中临床价值研究

Clinical value evaluation of early enteral nutrition combined with probiotics in patients with severe traumatic brain injury

目的:探讨早期肠内营养(EEN)联合益生菌在重型颅脑外伤病人中临床应用价值。方法:自2015年8月至2018年5月连续性纳入重型颅脑损伤病人72例,随机分为研究组及对照组,每组各36例。两组均给予EEN治疗,研究组额外添加益生菌。比较两组病人血清炎症因子、应激激素、肠道粘膜屏障指标以及EN并发症等差异。结果:两组一般临床资料未见统计学差异,具有可比性(P> 0.05)。至EN应用第7天,研究组血清肿瘤坏死因子α(P=0.034)、C反应蛋白(P=0.001)及皮质醇(P=0.038)浓度显著低于对照组;自EN应用第3天起,研究组血清血管紧张素Ⅱ、二胺氧化酶及D乳酸浓度显著低于对照组(P <0.05)。此外,EN应用过程中,研究组胃潴留(P=0.023)及下消化道麻痹(P=0.016)发生率显著低于对照组。结论:早期EN联合益生菌可有效降低重型颅脑外伤病人血清炎症因子及应激激素水平,保护肠道粘膜屏障,降低EN并发症。

Objective: To investigate the clinical value of early enteral nutrition(EEN) combined with probiotics in patients with severe traumatic brain injury(TBI). Methods: From August 2015 to May 2018, 72 patients with severe TBI were continuously enrolled and randomly divided into a study group and a control group, each group with 36 cases.Both groups were given early EN treatment, and the study group added probiotics. Serum inflammatory cytokines, stress hormones, intestinal mucosal barrier indicators and EN complications were compared between the two groups. Results:No statistically significant differences were found between groups in general clinical data(P > 0.05). At the 7th day after EN application, serum concentrations of tumor necrosis factor α(P = 0.034), C-reactive protein(P = 0.001) and cortisol(P = 0.038) in the study group were significantly lower than those in the control group. Since the 3rd day of EN application, serum concentrations of angiotensin Ⅱ, diamine oxidase and D-lactic acid in the study group were significantly lower than those in the control group(all P < 0.05). In addition, incidence of gastric retention(P = 0.023)and lower gastrointestinal paralysis(P = 0.016) was significantly lower in the study group. Conclusion: Early EN combined with probiotics can effectively reduce the level of serum inflammatory factors and stress hormones concentrations, protect the intestinal mucosal barrier, and reduce the incidence of EN complications in severe TBI patients.