不同时机营养支持在改善重型颅脑损伤患者营养状态及免疫功能中的应用

Application of nutritional support at different timings in improving nutritional status and immune function in patients with severe traumatic brain injury

目的探讨重型颅脑损伤(sTBI)患者采用不同时机营养支持对其营养状态以及免疫功能的影响。方法选取海南医学院第一附属医院神经外科自2020年9月至2021年9月收治的84例sTBI患者,根据营养支持时机的不同分为2组,其中早期组(45例)入院12 h内给予营养支持,延迟组(39例)入院48 h后给予营养支持。比较2组患者治疗前、治疗1周后应激状态[白细胞计数(WBC)、中性粒细胞计数(NEU)、血糖(Glu)]、营养指标[总蛋白(TP)、清蛋白(ALB)、血红蛋白(Hb)]、免疫功能指标[T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+))]以及并发症发生情况。结果治疗1周后,2组患者WBC、NEU、Glu均低于本组治疗前,且早期组低于延迟组,差异均有统计学意义(P<0.05);2组患者的TP、ALB、Hb指标水平及血清CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)值均明显高于本组治疗前,且早期组显著高于延迟组,差异均有统计学意义(P<0.05);早期组并发症发生率明显低于延迟组,且6个月内急性胃黏膜损伤的发生率以及死亡率均显著低于延迟组,差异均有统计学意义(P<0.05)。结论对sTBI患者实施早期营养支持能够有效改善其应激状态和营养状态,提高免疫功能,且有助于改善患者的预后。

Objective To investigate the influence of nutritional support at different timings on nutritional status and immune function in patients with severe traumatic brain injury(sTBI).Methods Eighty-four patients with sTBI admitted to Neurosurgery Department of the First Affiliated Hospital of Hainan Medical University were selected from September 2020 to September 2021 and were divided into two groups based on the different timings of nutritional support.The early group(45 cases)received nutritional support within 12 h of admission,while the delayed group(39 cases)received nutritional support after 48 h of admission.The stress state[white blood cell count(WBC),neutrophil count(NEU),blood glucose(Glu)],nutritional indicators[total protein(TP),albumin(ALB),hemoglobin(Hb)],immune function indicators[T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+))]and occurrence of complications of the two groups of patients were compared before treatment and after 1 week of treatment.Results After 1 week of treatment,the levels of WBC,NEU and Glu in the two groups were lower than those before treatment,and the early group had lower levels(P<0.05).The levels of TP,ALB,Hb,and serum CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the two groups after treatment were significantly higher than those before treatment,and the above levels in the early group were significantly higher than those in the delayed group(P<0.05).The incidence rates of complications in the early group were significantly lower than those in the delayed group,and the acute gastric mucosal injury and mortality within 6 months were significantly lower than those in the delayed group(P<0.05).Conclusion Early nutritional support for patients with sTBI can effectively improve the stress state and nutritional status,enhance the immune function,and contribute to the prognosis of patients.