重症颅脑外伤患者不同营养方案支持免疫学指标测定的临床意义  

Clinical Significance of Determination of Changes of Immuno-Function Parameters in Patients with Acute Severe Brain Injury on Different Froms of Nutritional Support

作　　者：马骏[1] 钱全安[1] 马云宝[2] 张晓懿[2] 朱静[2] 

机构地区：[1]扬州大学第五临床医学院常熟二院饮食中心营养室,215500 [2]扬州大学第五临床医学院常熟二院核医学科,215500

出　　处：《放射免疫学杂志》2009年第3期227-229,共3页Journal of Radioimmanology

摘　　要：目的:探讨经精氨酸强化后肠外+肠内营养(PN+EN)与全肠外营养(TPN)支持,对重症脑外伤病人免疫功能的影响。方法:将64例ICU救治的重症颅脑外伤患者分为两组,30例试验组接受PN+EN;对照组34例接受TPN,两组等氮、等热量供给。血清总蛋白、白蛋白、血红蛋白、转铁蛋白,均采用全自动生化分析法;血清IgA、IgG和IgM采用免疫比浊法。IL-2、IL-6和TNF-α采用放射免疫分析。结果:试验组和对照组两种营养支持前、后及两组营养支持后总蛋白(TP)和Alb测定结果均无显著的变化(P均>0.05)。而Hb和转铁蛋白(TF)水平两组患者营养支持前、后及两组营养支持后比较均明显升高(P均<0.05)。IgG水平试验组与对照组患者营养支持前、后及两组营养支持后比较均明显升高,差异均有显著性(P均<0.05),其余免疫学指标差异均无显著性意义(P均>0.05)。IL-2、IL-6和TNF-α三种细胞因子试验组经用PN+EN营养支持后水平恢复情况要明显优于对照组(P均<0.05)。结论:PN+EN较TPN改善脑外伤患者的免疫学功能更为明显。Objective To study the relationship between different forms of nutritional support and changes of serum nutritional as well as immuno - function parameters in patients with acute severe brain injury. Mothods Serum levels of total protein, albumin, hemoglobin, transferrin （with biochemistry）, immunoglobulins IgA, IgG, IgM （with immuno- turbidimetry） and cytokines IL- 2, IL-6, IL-8 （with RIA） were determined in 64 patients with acute severe brain injury both before and after 7 - 10ds＇ nutritional support. The 64 patients were divided into two groups：①experimental group, n =30, receiving parentral （70%） plus partial enteral （ 30% ） feedings ②control group, n = 34, receiving total parenteral untritional support exclusively with equal mitregen and calorie in-take in all the 64 patients. Results The serum levels of total protein, albumin, I-Ib and transferrin as well as other parameter in beth groups before nutritional support were about the same. After the course of nutritional support, the serum levels of total protein and albumin changed little in both groups, but the Hb and transferritin levels in both groups increased significantly （ P 〈 0.05 ） with the levels significantly higher in the experimental group than those in the control group （ P also 〈 0.05）. The serum immunoglobulins IgA, IgM levels changed verd littel, except that the IgG levels increased significantly in the experimental group after treatment （ P 〈 0.05 ） and were significantly higher than those in control group （ P also 〈 0. 05 ）. The serum cytokins levels in the control group changed little after the course of nutritional support, but the levels in the experimental group were greatly normalized and decreased significantly after treatment （P also 〈 0.05）. Conclusion Parenteral combined with partial enteral nutritional support could improve the nutritional as well as immuno - function status better than exclusive TPN did in patients with acute severe brain injury.

关 键 词：重症脑外伤 肠外+肠内营养 免疫学功能 全肠外营养 

分 类 号：R651.45[医药卫生—外科学] R593.242[医药卫生—临床医学]