重度颅脑损伤后吞咽障碍肠内外联合营养支持不同过渡时间对患者营养、免疫-炎症及并发症改善作用

The effect of different transitional time on patients'nutrition,immuneinflammation and complications in patients with dysphagia after severe craniocerebral injury

目的 探讨重度颅脑损伤后吞咽障碍肠内外联合营养支持不同过渡时间对患者营养、免疫-炎症及并发症改善作用。方法 选取2019年2月—2021年2月北京怀柔医院收治的77例重度颅脑损伤后吞咽障碍患者进行前瞻性研究,均给予肠内外联合营养支持,根据肠外完全过渡至肠内营养时间的不同分为≤5 d组(36例)、>5 d组(41例)。比较两组营养指标[人血白蛋白(ALB)、血红蛋白(Hb)、总蛋白(TP)]、免疫指标(CD3~+T细胞、CD4~+T细胞、CD8~+T细胞、CD4~+/CD8~+)、炎症指标[C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、中性粒细胞(NEU)]、格拉斯哥昏迷评分法(GCS)、美国国立卫生研究院卒中量表(NIHSS)评分、机械通气时间、重症加强护理病房(ICU)滞留时间、住院时间及并发症。结果≤5 d组干预7 d后ALB、Hb、TP高于>5 d组(P<0.05);≤5 d组干预7 d后CD3~+T细胞、CD4~+T细胞、CD4~+/CD8~+高于>5 d组(P<0.05);≤5 d组干预7 d后CRP、IL-6、TNF-α、NEU低于>5 d组(P<0.05);≤5 d组干预7 d后GCS评分高于>5 d组,NIHSS评分低于>5 d组(P<0.05);≤5 d组机械通气时间、ICU滞留时间、住院时间短于>5 d组(P<0.05);≤5 d组并发症发生率为5.56%(2/36),与>5 d组的9.76%(4/41)比较,差异无统计学意义(P>0.05)。结论 肠外营养早期完全过渡至肠内营养能改善重度颅脑损伤后吞咽障碍患者营养、炎症与意识状态,增强机体细胞免疫功能,减轻患者神经缺损症状,促进患者恢复,安全可靠。

Objective To investigate the effect of different transition time of enteral and parenteral nutritional support for patients with dysphagia after severe craniocerebral injury in improving nutrition,immune-inflammation and complications.Methods A retrospective study of 77 patients with dysphagia after severe craniocerebral injury admitted to Beijing Huairou hospital from February 2019 to May 2020 were selected for a retrospective study.They were all given combined parenteral and parenteral nutritional support,according to the time of complete transition from parenteral nutrition to enteral nutrition.Divided into≤5 d group(36 cases),>5 d group(41 cases).Compare the two groups of nutritional indicators[serum albumin(ALB),hemoglobin(Hb),total protein(PA)],immune indicators(CD3+T cells,CD4+T cells,CD8+T cells,CD4+/CD8+),inflammation indicators[C reaction Protein(CRP),Interleukin-6(IL-6),Tumor Necrosis Factor-α(TNF-α),Neutrophils(NEU)],Glasgow Coma Score(GCS),National Institutes of Health Stroke Scale(NIHSS)score,mechanical ventilation time,ICU stay time,hospital stay and complications.Results ALB,Hb and PA of≤5 d group were higher than>5 d group after 7 d intervention(P<0.05);CD3+T cells,CD4+T cells,CD4+/CD8+were higher than>5 d after 7 d intervention in≤5 d group(P<0.05);CRP,IL-6,TNF-α,NEU in the≤5 d group after 7 d intervention were lower than those in the>5 d group(P<0.05);GCS score in the≤5 d group was higher after 7 d intervention>5 d group,NIHSS score is lower than>5 d group(P<0.05);≤5 d group mechanical ventilation time,ICU stay time,hospital stay shorter than>5 d group(P<0.05);≤5 d group concurrent The incidence rate of symptom was 5.56%(2/36),compared with 9.76%(4/41)in the>5 d group,the difference was not statistically significant(P>0.05).Conclusion The early transition from parenteral nutrition to enteral nutrition can improve the nutrition,inflammation and consciousness of patients with dysphagia after severe head injury,enhance the body´s cellular immune function,reduce the symptoms of neurological deficits,and promote the recovery of patients.It is safe and reliable.