肠内加肠外营养对神经危重症患者早期营养和免疫功能的影响  

The effect of enteral plus parenteral nutrition on early nutrition and immune function in nerve critically ill patients

作　　者：杜鸿雁[1] 费兆霞[2] 孙莉[1] 高岚[1] 

机构地区：[1]吉林大学白求恩第一医院神经内科,吉林长春130021 [2]沈阳军区总医院神经内科,辽宁沈阳110000

出　　处：《中风与神经疾病杂志》2015年第4期357-361,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的分析肠内加肠外营养对神经危重症患者早期营养和免疫功能的影响。方法选择2013年6月-2014年2月在神经内科重症监护病房住院的危重患者共61例,随机将患者分为肠内营养（EN）组、肠内营养（EN）＋早期肠外营养（PN）组和肠内营养（EN）＋补充肠外营养（PN）组。比较3组患者在营养支持前和营养支持1w后的血清蛋白水平及免疫指标情况。结果单纯EN组患者入院1w后血清蛋白水平较入院时比较均降低,其中总蛋白、白蛋白、血红蛋白、转铁蛋白降低,具有显著差异（P〈0.05）;EN＋早期PN组、EN＋补充PN组患者入院1w后血清前白蛋白、视黄醇结合蛋白较入院时比较均有升高,具有显著差异（P〈0.05）;EN＋早期PN组、EN＋补充PN组的总蛋白、白蛋白、前白蛋白、转铁蛋白较EN组升高,具有显著差异（P〈0.05）;EN＋早期PN组、EN＋补充PN组治疗后TLC升高明显,显著高于EN组,差异有统计学意义（P〈0.05）。EN＋早期PN组治疗后前白蛋白指标较EN＋补充PN组升高,具有显著差异（P〈0.05）;EN＋早期PN组营养支持治疗后患者IgA、IgG较单纯肠内营养支持后升高明显,组间差异有统计学意义（P〈0.05）。结论短期内（1w）单纯肠内营养支持治疗导致血清蛋白下降和营养不良。急性期（1w）内,肠内、肠外联合营养较单纯肠内营养可改善神经危重症患者营养指标及免疫功能;早期添加肠外营养能改善危重患者的营养不良及免疫功能。Objective To investigate the effect of enteral plus parenteral nutrition on early nutrition and immune function in nerve critically ill patients. Methods We used a total of 61 critically illed patients in neurology intensive care unit from June 2013 to February 2014 in the First Hospital of Jilin University as the research object. Patients were randomly divided into the enteral group（ EN）,the early enteral nutrition（ EN） ＋ parenteral nutrition（ PN） and the enteral nutrition（ EN） ＋ supplement parenteral nutrition（ PN） group. To compare the serum protein levels,immune parameters in the three groups with different treatment methods. Results Comparison of the group and intra-group after treatment,statistical analysis of the data suggested that the serum protein levels of the EN group was decreased. For the EN ＋ early PN group and EN＋ supplemented PN group,the pre-albumin、retinol binding protein levels were increased after accepting treatment for one week,the difference was statistically significant（ P〈0. 05）. The total protein、albumin、pre-albumin、transferrin levels in the EN ＋ early PN group and EN ＋ supplemented PN group were higher than the EN group after treatment,the difference was statistically significant（ P〈0. 05）. Comparison of the three groups about the TLC levels after treatment,EN ＋ early PN group and EN ＋ supplemented PN group was higer than that in EN group,the difference was statistically significant（ P〈0. 05）. For the IGA、IGG levels. The EN ＋ early PN group was higer than these in the EN group after nutrition support. For the albumin,the EN ＋ early PN group was higher than that in the EN ＋ supplemented PN group after the treatment,the difference was statistically significant（ P〈0. 05）. Conclusion Simply enternal nutrition therapy in the short term（ one week） decreased the serum protein levels easily and result in malnutrition. For the acute phase（ one week）,the enteral plus parenteral nutrition is better than the simply

关 键 词：神经内科 神经危重症 肠内营养 肠外营养 

分 类 号：R743[医药卫生—神经病学与精神病学]