摘要
目的探讨免疫肠内营养剂对重型颅脑损伤患者的影响。方法选择2016年9月-2018年5月在我院重症医学科（ICU）收治的格拉斯评分小于等于8分、行机械通气的颅脑损伤患者49例，随机分为治疗组和对照组。治疗组使用免疫增强型肠内营养制剂瑞能，对照组使用其他整蛋白肠内营养制剂。观察指标肠内营养开通当天及第7天评估患者的营养状况及免疫学指标，如血红蛋白（Hb）、血清白蛋白（Alb）、血清前白蛋白（PA）、血清总蛋白（TP）、CD4、CD8、IgA、IgG、IgM，观察两组人住ICU期间的呼吸机相关性肺炎（VAP）发生机械通气时间（MV）、入住ICU时间。结果治疗7天后治疗组血红蛋白（Hb）、血清白蛋白（Alb）、血清前白蛋白（PA）、血清总蛋白（TP）、CD4、CD8、IgA、IgG、IgM比对照组显著升高，差异均有统计学意义[Hb（g／L）136．77±8．01比128．03±8．09，Alb（g／L）31．36±3．01比30．58±5．13，PA（g/L）186．25±20．32比182．49±20．61，TP（g/L）60．72±5．64比57．22±5．31，CD4（g）26．58±5．17比20．29±3．55，CD8（g）18．51±1．03比15．86±2．25．CD4／CD81．11±0．27比1．08±0．15，IgA（g/L）3．05±0．51比2．59±0．61，IgG（g／L）10．65±2．05比9．22±2．43，IgM（g／L）1．95±0．37比1．44±0．37，均P〈0．05]。治疗组VAP发生率、MV时间、入住ICU时间比对照组低，均有统计学意义[机械通气时间（d）8．78比11．3，VAP发生率（n（％））6／24比8／33．3，入院ICU时间（d）12．48比15．66，（P〈0．05）1。结论瑞能对重型颅脑损伤患者营养状况、免疫功能改善有一定作用，减少呼吸机相关性肺炎的发生、缩短ICU住院天数，能改善临床疗效。
Objective To discuss the effect of enteral immunonutrition in patients with the severe traumatic brain injury. Methods 49 patients with severe traumatic brain injury （GCS ≤ 8） who were using mechanical ventilation were selected from September 2016 to May 2018 in Intensive Care Unit （ICU） of The People＇s Hospital of Fenghua and were randomly divided into experimental group and control group. The experimental group was given enhanced enteral immunonutrition （Supportan）, while other types of mixture suspension of protein-fiber enteral nutrition treated patients in the control group. The nutritional status and immunological indicators, such as Hb, Alb, PA, TP, CD4, CDS, IgA, IgG, IgM, were evaluated at the first day and the seventh day of applying enteral immunonutrition to patients as well as observing the happening rate of ventilator associated pneumonia during the period of staying in ICU, the time of using mechanical ventilation, and the staying time in ICU. Results 7 days after treatment, the serum Hb, Alb, PA, TP, CD4, CDS, IgA, IgG, IgM were significantly higher than those before the treatment, and the differences were statistically significant [Hb（g/L）： 136.77±8.01 vs. 128.03±8.09, Alb（g/L）31.36±3.01 vs. 30.58±5.13, PA（g/L） 186.25±20.32 vs. 182.49±20.61, TP（g/L）： 60.72±5.64 vs. 57.22±5.31, CD4（g） 26.58±5.17 vs. 20.29±3.55, CD8 （g） 18.51±1.03vs. 15.86±2.25, CD4/CD8 1.11±0.27 vs. 1.08±0.15, IgA （g/L） 3.05± 0.51 vs. 2.59±0.61, IgG （g/L） 10.65±2.05 vs. 9.22±2.43, IgM （g/L） 1.95±0.37 vs. 1.44±0.37, all P 〈 0.05]. As for the happening rate of ventilator associated pneumonia, the usage time for mechanical ventilation, and the time period in ICU, the experimental group was lower than the other group, and the differences were statistically significant [duration of mechanical ventilation （d）： 8.78 vs. 11.3, VAP rate （n（%））： 6/24 vs. 8/33.3, ICU admission time （d）： 12.48 vs. 15.66, all P 〈 0.05]. Conclusion Supportan ha
作者
栗洁
张斌
周晶
Li Jie;Zhang Bin;Zhou Jing(The People＇s Hospital of Fenghua,Ningbo 315500,Zhejiang,China)
出处
《医院与医学》
2018年第3期58-60,67,共4页
Hospital and Medicine
关键词
免疫肠内营养剂
重型颅脑损伤
肠内营养
Enteral immunonutrition
Severe traumatic brain injury
Enteral nutrition
