神经外科中老年重症患者给予早期低剂量肠内营养的临床研究

Clinical study of early low-dose enteral nutrition in the critically ill middle-aged and elderly patients in neurosurgery

目的:探讨神经外科中老年重症患者给予早期低剂量肠内喂养的效果。方法:选择2020年4月至2022年4月联勤保障部队第904医院神经外科收治的中老年重症患者102例,根据治疗方式将行早期标准剂量肠内营养的患者作为对照组(n=51),行早期低剂量肠内营养的作为试验组(n=51)。对比2组治疗前后营养状况、细胞免疫指标、体液免疫指标变化情况,并记录胃肠道耐受情况及预后效果。结果:治疗第7、14天,试验组与对照组血清总蛋白(total protein,TP)、白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)水平差异均无统计学意义(均P>0.05);试验组治疗7 d内胃潴留、腹泻、胃食管反流发生率均低于对照组(均P<0.05);试验组治疗第7、14天的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组,CD8^(+)水平低于对照组(均P<0.05);试验组治疗第7、14天的免疫球蛋白A(immunoglobulin A,IgA)、免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白M(immunoglobulin M,IgM)均高于对照组(均P<0.05);试验组ICU住院时间、呼吸机支持时间均短于对照组(均P<0.05),总住院时间、病死率与对照组相比,差异均无统计学意义(均P>0.05)。结论:神经外科中老年重症患者给予早期低剂量肠内喂养治疗短期内不会影响营养状况,还可提升胃肠道耐受,增强免疫功能,从而改善预后。

Objective:To investigate the effect of early low-dose enteral feeding on critically ill middle-aged and elderly patients in neurosurgery.Methods:A total of 102 middle-aged and elderly patients with severe diseases admitted to neurosurgery in 904 Hospital of Joint Support Forces were selected from April 2020 to April 2022.According to different treatment methods,51 patients who received early standard dose enteral nutrition as the control group,and 51 patients who received early low dose enteral nutrition as the test group.The changes of nutritional status,cellular immune index,and humoral immune index before and after treatment were compared between the 2 groups,and gastrointestinal tolerance and prognosis were recorded.Results:The levels of total protein(TP),albumin(ALB)and prealbumin(PA)in the test group on the 7th and 14th days after the treatment were not statistically different from those in the control group(all P>0.05);the incidence of gastric retention,diarrhea and gastroesophageal reflux in the test group within 7 days after treatment were lower than those in the control group(all P<0.05);The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the test group on the 7th and 14th day of treatment were higher than those in the control group,and the level of CD8^(+)were lower than that in the control group(all P<0.05);the IgA,IgG and IgM in the test group were higher than those in the control group on the 7th and 14th day of the treatment(all P<0.05);the length of stay in ICU and the duration of ventilator support in the test group were shorter than those in the control group(both P<0.05),and the total length of hospital stay and mortality were not significantly different from those in the control group(both P>0.05).Conclusion:Early low-dose enteral feeding in the critically ill middle-aged and elderly patients in neurosurgery will not affect the nutritional status in the short term,but can also enhance gastrointestinal tolerance and immune function,thus improve the prognosis.