不同时机营养支持对重型颅脑损伤患者营养状态与免疫功能及临床预后的影响

Effects of nutritional support at different times on nutritional status,immune function and clinical prognosis of patients with severe craniocerebral injury

目的 探讨对重型颅脑损伤患者给予不同时机营养支持后在营养状态、免疫功能及临床预后方面的影响。方法 择取2021年2月—2022年5月漯河市中心医院收诊的58例重型颅脑损伤患者,根据营养支持时机的不同分为早期组与延迟组。早期组36例,在入院12 h内给予营养支持;延迟组22例,在入院48 h后给予营养支持。对比两组患者的急性生理与慢性健康评分(Acute Physiology and Chronic Health Evaluation, APACHEII评分)、微型营养评价(mini-nutritional assessment, MNA)评分、红细胞分布宽度(RDW)、营养指标、免疫功能指标、并发症及预后情况,分析研究数据形成统计学报告。结果 入院时两组APACHEII、MNA、RDW评分比较无统计学意义(P>0.05);入院7 d后,两组各项指标情况均得到改善,且早期组APACHEII与RDW评分(20.42±1.85)分与(12.62±0.69)分,均低于延迟组,MNA评分(29.30±6.65)分,高于延迟组(P<0.05);入院时两组总蛋白(TP)、清蛋白(ALB)、血红蛋白(Hb)水平比较无统计学意义(P>0.05);入院7 d后两组各项指标水平均上升,且早期组TP、ALB、Hb水平分别是(58.93±3.15)g/L、(245.50±31.17)mg/L、(129.42±18.45)g/L,均高于延迟组(P<0.05);入院时两组血清免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、淋巴细胞CD4、CD8指标比较无统计学意义(P>0.05);入院7 d后两组各项免疫指标显著改善,且早期组IgG、IgA、CD4、CD8水平分别是(14.68±2.80)g/L、(2.72±0.64)g/L、(35.60±4.34)%、(24.89±4.26)%,均高于延迟组(P<0.05);早期组腹泻、呕吐、出血、急性胃黏膜损伤发生率及死亡率分别为8.33%、5.56%、2.78%、5.56%、2.78%,均低于延迟组(P<0.05)。结论 将早期营养支持应用于重型颅脑损伤患者的治疗中,能够有效改善患者的身体健康情况,提升其营养状况与免疫力,降低并发症发生风险,提高预后效果,值得在临床广泛推广应用。

Objective To explore the effects of nutritional support at different times on nutritional status, immune function and clinical prognosis of patients with severe craniocerebral injury.Methods Fifty-eight patients with severe craniocerebral injury admitted to our hospital from February 2021 to May 2022 were included in the study, and divided into early group and delayed group according to the timing of nutritional support. 36 patients in the early group were given nutritional support within 12 h after admission. In the delayed group, 22 patients were given nutritional support 48 h after admission. The APACHEII score, MNA score, RDW, nutritional indexes, immune function indexes, complications and prognosis of the two groups were compared, and the study data were analyzed to form a statistical report.Results There was no significant difference in APACHEII, MNA and RDW scores between the two groups at admission(P>0.05). Seven days after admission, all indexes of the two groups were improved, and the APACHEII and RDW scores of the early group(20.42±1.85) and(12.62±0.69) were lower than those of the delayed group, and the MNA scores of the early group(29.30±6.65) were higher than those of the delayed group(P<0.05). There was no significant difference in total protein(TP), albumin(ALB) and hemoglobin(Hb) levels between the two groups at admission(P>0.05). 7 days after admission, the levels of all indexes in both groups increased, and the levels of TP, ALB and Hb in the early group were(58.93±3.15) g/L,(245.50±31.17) mg/L and(129.42±18.45) g/L, respectively, which were higher than those in the delayed group(P<0.05). There was no significant difference in serum immunoglobulin G(IgG), immunoglobulin A(IgA), lymphocyte CD4 and CD8 between the two groups at admission(P>0.05). 7 days after admission, the immune indexes of the two groups were significantly improved, and the IgG, IgA, CD4 and CD8 levels in the early group were(14.68±2.80) g/L,(2.72±0.64) g/L,(35.60±4.34) % and(24.89±4.26) %, respectively, which were higher than those in the delayed group(P<0.05). The incidence and mortality of diarrhea, vomiting, bleeding and acute gastric mucosal injury in early group were 8.33%, 5.56%, 2.78%, 5.56% and 2.78%, respectively, which were lower than those in delayed group(P<0.05).Conclusion The application of early nutrition support in the treatment of patients with severe craniocerebral injury can effectively improve the physical health of patients, improve their nutritional status and immunity, reduce the risk of complications, improve the prognosis, and is worthy of widespread clinical application.