添加益生菌的早期肠内营养对重型颅脑损伤病人TNF-α和IL-6的影响  

Influence of early enteral nutrition supplemented with probiotics on TNF-α and IL-6 of patients with severe traumatic brain injury

作　　者：谢彩霞[1] 朱京慈[2] 温贤秀[1] 石荷叶[1] 尹华华[2] 蔡王婷[1] 

机构地区：[1]四川省医学科学院.四川省人民医院 [2]中国人民解放军第三军医大学护理学院

出　　处：《护理研究（中旬版）》2012年第10期2702-2705,共4页Chinese Nursing Researsh

基　　金：全军医药卫生科研基金课题;编号:09MA009;重庆市自然科学基金资助课题;编号:CSTC;2008BB5289

摘　　要：[目的]探讨添加益生菌的肠内营养对重型颅脑损伤病人外周血促炎因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和全身炎性反应的影响。[方法]将49例重型颅脑损伤病人随机分为早期肠内营养组(EEN组)和添加益生菌的早期肠内营养组(EENP组)。EEN组于伤后24h～48h采用肠内营养制剂(瑞素)开始营养支持;EENP组在EEN组的基础上,在肠内营养支持的前14d添加了益生菌制剂(金双歧)。在肠内营养支持前、第4天、第8天和第15天分别收集外周血测定TNF-α、IL-6并进行全身炎症反应综合征评分。同时以健康成年人30例设立正常对照组(C组),单次采集血标本做正常参考值。[结果]营养支持0d,EEN组和EENP组外周血促炎因子TNF-α和IL-6含量显著高于C组(P<0.01),EEN组和EENP组间差异无统计学意义(P>0.05);营养支持8d,EENP组TNF-α显著低于EEN组(P<0.05);营养支持15d,EENP组TNF-α和IL-6均低于EEN组(P<0.05),但与C组相比,均未恢复至正常水平(P<0.05)。整个研究期间两组病人全身炎症反应综合征评分比较差异无统计学意义(P>0.05)。[结论]重型颅脑损伤病人促炎因子TNF-α和IL-6过度释放,添加益生菌的早期肠内营养可一定程度减少TNF-α和IL-6的产生。objectives：To probe into influence of early enteral nutrition supplemented with probiotics on TNF-α,IL-6 and systemic inflammatory response of patients with severe traumatic brain injury.Methods：A total of 49 patients with severe traumatic brain injury were randomly divided into early enteral nutrition group（group EEN） and early enteral nutrition combined with probiotics group（group EENP）.The patients in group EEN started receiving enteral nutrition（RuiSu） within 24 to 48 hours after injury,patients in group EENP received an enteral nutritional support same to group EEN,but probiotics（Golden Bifid）was addedin the first 14 days of enteral nutritional support.Peripheral blood was collected,before enteral natrition support day4th,day8th,day15th after enteral nutrition support for dynamic observation of TNF-α and IL-6.In addition,to analyze the clinical effect,systemic inflammatory response syndrome was observed on day 0,day 4,day 8,day 15 of nutritional support.In group C,only blood samples were collected to do the normal reference values.Results：On nutritional support day 0,peripheral blood pro-inflammatory cytokines TNF-α and IL-6 in group EEN and group EENP were significant higher than group C（P0.01）,there was no statistical significant difference between two groups（P0.05）.On nutritional support day 8,TNF-α in group EENP was significant lower than that of the group EEN（P0.05）.On nutritional support day 15,TNF-α and IL-6 in group EENP were significant lower than group EEN（P0.05）,but TNF-α and IL-6 in group EENP still did not recover to normal level（P0.05）.The systemic inflammatory response syndrome in group EENP was lower than that of the group EEN,but there was no statistical significant difference（P0.05）.Conclusion：Pro-inflammatory cytokines TNF-α and IL-6 release excessively in patients with severe traumatic brain injury,early enteral nutrition supplemented with probiotics can reduce it in some extent.

关 键 词：重型颅脑损伤 肠内营养 肿瘤坏死因子-α 白细胞介素-6 全身炎症反应综合征 

分 类 号：R473.6[医药卫生—护理学]