内镜辅助下早期肠内营养对重症高血压脑出血患者免疫功能和炎症反应的影响

Effects of endoscope-assisted early enteral nutrition on immune function and inflammatory response in patients with severe hypertensive intracerebral hemorrhage

目的探讨内镜辅助下早期肠内营养方式对重症高血压脑出血患者营养、炎症反应、免疫功能、并发症和预后的影响,为选择最有效的肠内营养途径提供依据。方法采用前瞻平行对照研究,选取收治的重症高血压脑出血患者,按随机数字表法分为胃管组、肠管组(每组30例,营养液相同)。比较两组治疗前及治疗后第14天患者一般状况、预后及并发症。采用酶联免疫吸附测定法(ELISA)检测患者炎性因子:肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6);采用流式细胞仪测定CD4^(+)、CD8^(+)、TLC;透射比浊法检测白蛋白、前蛋白及免疫球蛋白IgA、IgM、IgG含量;采用GOS评分评定患者预后。结果14 d后,两组患者各营养、免疫、炎症指标均较第1天结果明显改善(P<0.05),肠管组各项指标均优于胃管组(P<0.05);并发症发生率在消化道出血、反流性食管炎、胃潴留、呕吐、吸入性肺炎、便秘方面内镜下肠管组各项指标均优于胃管组(P<0.05),在腹泻、鼻出血方面两组差异无统计学意义(P>0.05);患者预后(GOS评分)肠管组优于胃管组(P<0.05),APACHEⅡ评分肠管组较胃管组明显降低(P<0.05)。结论综合两种肠内营养支持方式对重症高血压脑出血患者的营养、免疫、炎症、并发症及预后指标的影响,早期胃镜辅助下鼻肠管为重症高血压脑出血患者首选肠内营养方式。

Objective To evaluate the effects of endoscope-assisted early enteral nutrition on nutrition,inflammatory response,immune function,complications and prognosis in patients with severe hypertensive intracerebral hemorrhage;so as to provide experience for effective selection of enteral nutrition.Methods The patients with severe hypertensive intracerebral hemorrhage were included.A prospective paralleled controlled trial was conducted.All cases were randomly divided into gastric tube group and intestinal tube group(n=30).The general status and complications of the two groups were compared before treatment and 14 days after treatment.Inflammatory factors such as tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were assessed by enzyme-linked immunosorbent assay(ELISA).Meanwhile,CD4^(+),CD8^(+) and total lymphocyte counts(TLC)were measured by flow cytometry.The contents of albumin,preprotein and immunoglobulin IgA,IgM and IgG were measured by transmission turbidimetry,and the prognosis was evaluated by GOS score.Results There were no significant differences in sex,age,body mass index(BMI),GCS score,operation and tracheotomy,acute physiology and chronic health score(APACHEII score),nutrition status,immunity or inflammation between the 2 groups before treatment.After 14 days,the indexes of nutrition,immunity and inflammation in the both groups were significantly better than those on the first day(P<0.05).The indexes in intestinal tube group were significantly better than those in gastric tube group(P<0.05).The incidence of complications in gastrointestinal bleeding,reflux esophagitis,gastric retention,vomiting and aspiration pneumonia in nasointestinal group were significantly lower than those in gastric tube group.There were no significant differences in diarrhea,constipation or epistaxis between the two groups(P>0.05).The prognosis(GOS score)of the intestinal group was significantly better than that of the gastric tube group(P<0.05).The APACHEⅡ score of intestinal tube group was significantly lower than that of gastric tube group(P<0.05).Conclusion According to the nutrition,immunity,inflammation,complications and prognosis of patients with severe hypertensive intracerebral hemorrhage supported by two kinds of enteral nutrition,naso-intestinal tube under gastroscope is the first choice for patients with severe hypertensive intracerebral hemorrhage.