摘要
目的观察早期持续肠内营养支持对重症脑卒中的临床疗效,探讨其对免疫功能、预后的影响。方法选择86例重症脑卒中患者,随机分为对照组和观察组,每组43例。在常规治疗的基础上,对照组予分次集中喂食,观察组予持续肠内营养支持,疗程21 d,测定比较2组营养指标(ALB、Hb、TG)、免疫指标(IgA、IgG、IgM)、神经功能缺损评分(NIHSS评分)的差异,比较2组感染率及病死率。结果研究第1天,2组的各营养指标、免疫指标及NIHSS评分差异均无统计学意义。至第10天,2组的ALB、Hb、TG、IgA、IgG、IgM等均较第1天显著下降(P<0.05)。至第21天,对照组ALB、Hb、TG分别为(35.28±4.65)g/L、(115.16±11.92)g/L、(0.91±0.24)mmol/L,均较第1天呈下降趋势(P<0.01),而观察组ALB、Hb、TG分别为(38.16±5.13)g/L、(127.31±11.85)g/L、(1.46±0.35)mmol/L,各指标均显著高于对照组(P<0.01),且与第1天比较差异无统计学意义(P>0.05)。对照组第21天的IgA、IgG、IgM分别为(2.27±0.39)g/L、(9.01±1.93)g/L、(1.39±0.31)g/L,均较第1天呈下降趋势(P<0.01),而观察组第21天的IgA、IgG、IgM分别为(2.83±0.53)g/L、(11.28±2.05)g/L、(1.78±0.41)g/L,显著高于对照组(P<0.01)。观察组总感染率为23.3%,显著低于对照组的总感染率55.8%(P<0.01)。至21 d,观察组的神经功能缺损评分显著低于对照组(P<0.01),对照组3月内病死率为11.6%,亦高于观察组的4.7%,但差异无统计学意义(P>0.05)。结论早期持续肠内营养支持可更好地促进重症脑卒中患者神经功能的恢复,改善疾病预后,在一定程度上减少病死率,其机制可能与改善营养状态、促进免疫功能的恢复有密切关系。
Objective To observe the efficacy of early continued enteral nutrition support in severe stroke patients and its effect on immune function and prognosis. Methods A total of 86 cases of severe stroke were randomly divided into con- trol group and observation group with 43 cases in each gorup. On the base of conventional treatment,the control group was fed concentrated ,and observation group was given continued nutritional support,the course of treatment was 21 days. The nutrition indicators （ ALB, Hb,TG） ,immune parameters （ IgA, IgG, IgM ）, neurological deficits （ NIHSS score） were deter- mined and compared in the two groups, and infection rates and mortality were also compared. Results On day 1, the nu- trition indicators ,immune parameters and NIHSS scores of both groups were not statistically different. To 10 days, ALB, Hb,TG,IgA,IgG and IgM in both groups was significantly decreased than the first day（P 〈0.05）. To 21 days,the level of ALB,Hb,TG in the control group was（35.28 -e4.65 ） g/L, （ 115.16 ± 11.92） g/L, （0.91 ±0.24） mmol/L,respec- tively, which all continued to show a downward trend, but the level of ALB, Hb and TG in the control group was （38.16 5.13） g/L, （ 127.31 11.85 ） g/L, （ 1.46 0.35 ） mmol/L, respectively, which were all higher than that of control group （P 〈 O. 01 ） and was no significantly different compared to the first day （P 〉 O. 05 ）. To 21 days, the level of IgA, IgG and IgM in the control group was（2.27 0.39） g/L, （9. O1 ± 1.93） g/L, （ 1.39 ±0.31 ） g/L,respectively,but the level of IgA, IgG and IgM in the control group was （2.83 O. 53 ） g/L, （ 11.28 2.05 ） g/L, （ 1.78 O. 41 ） g/L, respectively, which were all higher than that of control group（ P 〈 O. 01 ） and was no significantly different compared to the first day （ P 〉 0.05 ）. The total infection rate of observation group was 23.3 %, which was significantly lower than that in the con- trol group （55.8 % ） , P 〈 O. 01. To 21 days,
出处
《中华全科医学》
2014年第4期554-556,共3页
Chinese Journal of General Practice
关键词
肠内营养
重症脑卒中
免疫功能
预后
Enteral nutrition
Severe stroke
Immune function
Prognosis
