不同温度肠内营养液对重型颅脑损伤患者TP、HSA、PAB、IL-6、IL-8及免疫功能的影响

Effects of enteral nutrition solution with different temperature on TP,HSA,PAB,IL-6,IL-8 and immune function in patients with severe craniocerebral injury

目的探究不同温度的肠内营养液对重型颅脑损伤患者血清总蛋白(total protein,TP)、血清白蛋白(human serum albumin,HSA)、前白蛋白(prealbumin,PAB)水平、白细胞介素–6(interleukin–6,IL–6)、白细胞介素–8(interleukin–8,IL–8)及免疫功能的影响。方法选取2019年4月至2020年4月在浙江大学医学院附属第二医院临平分院收治的重型颅脑损伤患者100例。采用数表法随机分为研究组和对照组,每组各50例,两组均使用肠内营养液进行治疗,对照组肠内营养液未经过加温输注,研究组肠内营养液经过加温输注。采用全自动生化分析仪检测TP、HSA、PAB水平,酶联免疫吸附试验检测IL–6、IL–8水平,流式细胞仪检测CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+);观察肠内营养暂停次数,统计观察两组并发症发生率。结果治疗前两组患者的TP、HSA、PAB、IL–6、IL–8、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比较,差异均无统计学意义(P>0.05)。治疗后两组患者的TP、HSA、PAB、CD4^(+)、CD4^(+)/CD8^(+)高于治疗前,IL–6、IL–8、CD8^(+)低于治疗前,差异均有统计学意义(P<0.05)。治疗后研究组的TP、HSA、PAB、CD4^(+)、CD4^(+)/CD8^(+)高于对照组,IL–6、IL–8、CD8^(+)低于对照组,差异均有统计学意义(P<0.05)。研究组患者1d肠内营养累及暂停次数、3d肠内营养累及暂停次数、7d肠内营养累及暂停次数少于对照组,差异均有统计学意义(P<0.05)。研究组患者胃潴留、腹胀、腹泻、返流、呕吐少于对照组,差异均有统计学意义(P<0.05)。结论不同温度的肠内营养液对重型颅脑损伤患者的胃肠道并发症具有一定影响,且给予患者加温肠内营养液可降低患者胃潴留、腹胀、腹泻、返流、呕吐的发生,减轻炎性反应,提高免疫功能,稳定胃肠道指标。

Objective To explore the effect of different temperatures of enteral nutrition solution on serum total protein(TP),human serum albumin(HSA),prealbumin(PAB),interleukin–6(IL–6),interleukin–8(IL–8)and immune function.Methods A total of 100 patients with severe craniocerebral injury who were admitted to the Second Hospital of Zhejiang University Medical College Linping Branch,from April 2019 to April 2020 were selected and randomly divided into the study group and the control group,50 cases in each group.Both groups were treated with enteral nutrition solution.The enteral nutrition solution in the control group was not infused with heating,and the enteral nutrition solution in the study group was infused with heating.The levels of TP,HSA and PAB were detected by automatic biochemical analyzer;the levels of IL–6 and IL–8 were detected by enzyme–linked immunosorbent assay;CD4^(+),CD8^(+),CD4^(+)/CD8^(+)were detected by flow cytometry;the times of enteral nutrition suspension were observed.The incidence of complications in the two groups was observed statistically.Results There was no significant difference in TP,HSA,PAB,IL-6,IL-8,CD4^(+),CD8^(+),CD4^(+)/CD8^(+)between the two groups before treatment,the differences were statistically significant(P>0.05).After treatment,TP,HSA,PAB,CD4^(+),CD4^(+)/CD8^(+)in the two groups were higher than those before treatment,and IL-6,IL-8,and CD8^(+)were lower than those before treatment,with statistical differences(P<0.05).HSA,PAB,CD4^(+),CD4^(+)/CD8^(+)were higher than the control group,IL-6,IL-8,CD8^(+)were lower than the control group,with statistical differences(P<0.05).The number of pauses involved in enteral nutrition on 1 day,the number of pauses involved in enteral nutrition on 3 days,and the number of pauses involved in enteral nutrition on 7 days in the study group were less than those in the control group,with statistical differences(P<0.05).Gastric retention,abdominal distension,diarrhea,reflux,and vomiting in the study group were less than those in the control group,with statistical difference(P<0.05).Conclusion Enteral nutrition fluid with different temperatures has a certain impact on gastrointestinal complications in patients with severe craniocerebral injury,and the administration of warm enteral nutrition fluid can reduce the occurrence of gastric retention,abdominal distension,diarrhea,reflux and vomiting,reduce inflammatory response,improve immune function,and stabilize gastrointestinal indicators.