添加益生菌的早期肠内营养对重型颅脑损伤患者血清炎症因子与肠黏膜屏障功能的影响  

Influence of early enteral nutrition with added probiotics on serum inflammatory factors and intestinal mucous membrane barrier function of patients with severe brain injury

作　　者：姜明明[1,2] 方强[1] 孙勤[2] 徐伟华[2] 胡雪忠[2] 邵唐宏 

机构地区：[1]浙江大学医学院附属第一医院重症医学科,浙江杭州310003 [2]慈溪市人民医院重症医学科,浙江慈溪315300 [3]慈溪市人民医院检验科,浙江慈溪315300

出　　处：《中国微生态学杂志》2015年第10期1177-1180,共4页Chinese Journal of Microecology

摘　　要：目的探讨添加益生菌的早期肠内营养对重型颅脑损伤患者血清炎症因子与肠黏膜屏障功能的影响。方法选择72例重度颅脑损伤患者随机分为观察组（n=36例）和对照组（n=36例）。两组入院后或术后予以控制颅内压及血压、预防感染、保护胃黏膜和营养脑细胞等基础治疗,对照组予以早期留置胃管鼻饲行肠内营养治疗,百普力肠内营养液恒速灌注,开始为500mL/d,后逐渐加量至1 500~2 000mL/d。观察组在对照组治疗基础上加用双歧三联活菌肠溶胶囊630mg研磨水化后自鼻饲管内注入,3次/d,连用14d。观察两组治疗前和治疗14d后GCS评分、血清炎症因子[白介素（IL）-6、肿瘤坏死因子（TNF）-α]指标及胃肠黏膜屏障功能[D-乳酸和前降钙素（PCT）]指标的变化。结果治疗14d后,两组GCS评分较前明显上升（P〈0.05或P〈0.01）,且观察组比对照组上升更明显（P〈0.05）;同时两组血清IL-6和TNF-α指标较前明显下降（P〈0.05或P〈0.01）,且观察组比对照组下降更明显（P〈0.05）;同时两组血清D-乳酸和PCT指标较前明显下降（P〈0.05或P〈0.01）,且观察组下降比对照组更明显（P〈0.05）。结论添加益生菌的早期肠内营养辅助治疗重型颅脑损伤患者可提高其GCS评分,下调血清促炎症因子IL-6和TNF-α指标,抑制机体炎症反应;并可降低血清D-乳酸和PCT指标,保护与修复其胃肠黏膜屏障,改善其胃肠功能。Objective To discuss the influence of early enteral nutrition with added probiotics on serum in- flammatory factors and intestinal mucous membrane barrier function of patients with severe brain injury. Methods 72 patients with severe brain injury were selected and divided into observation group （n=36 ca- ses） or control group （n=36 cases） at random. Both groups were given the same basic treatment. The pa- tients in control group were additionally given enteral nutrition therapy by early nasogastric tube feeding Peptison enteral nutrition liquid, while the patients in observation group were additionally given 630rag Bifid Triple Viable Bacteria Enteric Coated Capsules by nasogastric feeding tube. The changes of GCS, serum in-flammatory factors including interleukiw6 （IL-6） and tumor necrosis factor-α （TNF-α）, and gastrointestinal mucosal barrier function indexes Dqactic acid and procalcitonin （PCT） in both groups were observed before and 14 days after the treatment. Results After 14 days＂ treatment, the GCS of patients in both groups obvi- ously rose （P〈0.05 or P〈0.01）, with the observation group superior to the control group （P〈0.05）. The serum IL-6 and TNF-α levels in both groups obviously declined （P〈0.05 or P〈0.01）, with the decli- ning rate in observation group much higher than that in control group （P〈0.05）. Meanwhile, the serum D- lactic acid and PCT levels in both groups obviously declined （P〈0.05 or P〈0.01）, and the declining rate in observation group was much higher than that in control group （P〈0.05）. Conclusion The application of early enteral nutrition with added probiotics as adjunctive therapy （AT） for severe brain injury can raise GCS, down-regulate serum inflammatory factors IL-6 and TNF-α, inhibit inflammatory reaction, reduce ser- um D-lactic acid and PCT markers, protect and repair intestinal mucous membrane barrier and improve gas- trointestinal function.

关 键 词：重型颅脑损伤 益生菌 早期肠内营养 炎症因子 肠黏膜屏障 

分 类 号：R473.6[医药卫生—护理学]