早期含益生菌肠内营养支持方案对重型颅脑损伤患者血清白蛋白水平、炎性细胞因子及GCS评分的影响  

Effect of different early nutritional support programs on serum protein, inflammatory cytokines, and Glasgow Coma Scale score in patients with severe craniocerebral injury

作　　者：刘伟贤[1] 龚杰[1] 赵东 汤朱骁 陈亮[1] 陈钟樑 沈峥[1] Wei-Xian Liu;Jie Gong;Dong Zhao;Zhu-Xiao Tang;Liang Chen;Zhong-Liang Chen;Zheng Shen(Department of Neurosurgery, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China)

机构地区：[1]浙江医院神经外科,浙江省杭州市310013

出　　处：《世界华人消化杂志》2018年第13期803-809,共7页World Chinese Journal of Digestology

摘　　要：目的比较在重型颅脑损伤患者中早期应用不同营养支持方案,对其血清白蛋白、炎性细胞因子和GCS评分的影响.方法回顾性分析2012-04/2017-04期间150例重型颅脑损伤患者的临床资料,其中70例患者在早期给予普通肠内营养支持方案,作为对照组;80例患者在早期给予含益生菌的肠内营养支持方案,作为观察组.比较两组患者的血清白蛋白水平、炎性细胞因子及GCS评分.结果治疗后1、2 wk,观察组患者的血清白蛋白水平分别为39.22±2.58、41.31±2.61,高于对照组的35.03±1.91、36.92±1.93,差异均具有统计学意义(P<0.05);观察组患者的血红蛋白水平分别为103.68±11.56、107.32±11.41,高于对照组的94.19±10.81、95.12±10.87,差异具有统计学意义(P<0.05);治疗后1 wk,观察组患者的IL-6、TNF-α值、D-乳酸值及PCT值分别为87.33±18.61、6.28±1.06、1.25±0.21、4.15±0.86,低于对照组的113.76±20.35、8.22±1.58、2.39±0.46、7.12±1.01,差异具有统计学意义(P<0.05);治疗后2 wk,观察组患者的IL-6、TNF-α值、D-乳酸值及PCT值分别为85.35±17.32、5.92±1.01、1.09±0.19、4.05±0.71,低于对照组的110.91±18.93、8.31±1.61、2.28±0.37、7.08±1.22,差异具有统计学意义(P<0.05);治疗后1、2 wk,观察组患者的GCS评分分别为12.08±1.52、13.26±1.72,高于对照组的10.28±1.37、11.31±1.41,差异有统计学意义(P<0.05);观察组患者的住院时间、住院费用、肠内营养时间及住院期间死亡率分别为21.28±7.16、8.38±1.96、17.66±5.71、16.25%,低于对照组的27.43±8.23、11.65±2.67、23.19±7.33、28.57%,差异均有统计学意义(P<0.05);观察组患者出院后6 mo的GOS评分为4.32±1.25,高于对照组的3.11±0.91,差异具有统计学意义(P<0.05).结论在重型颅脑损伤患者中早期应用含益生菌的肠内营养治疗方案,能够显著改善患者的营养状态,减轻炎性反应,提高患者的GCS评分.AIM To compare the effect of different nutritional support programs on serum protein, inflammatory cytokines, and Glasgow Coma Scale （GCS） score in patients with severe craniocerebral injury （SCCI）. METHODS The clinical data of 150 patients with SCCI treated from April 2012 to April 2017 were retrospectively analyzed. Among them, 70 patients were given general enteral nutrition support in the early stage （control group）, and 80 patientS were given early enteral nutrition support program containing probiotics （observation group）. The two groups of patients were compared in serum protein levels, inflammatory cytokines, GCS score, and other indicators.RESULTS At weeks 1 and 2 after treatment, serum protein levels （39.22 ± 2.58 vs 35.03 ± 1.91, 41.31 ± 2.61 vs 36.92 ± 1.93, P 〈 0.05） and hemoglobin levels （103.68 ± 11.56 vs 94.19 ± 10.81, 107.32 ± 11.41 vs 95.12 ± 10.87, P 〈 0.05） were significantly higher and the levels of IL-6, TNF-α, D-lactate, and PCT （week 1：87.33 ± 18.61 vs 113.76 ± 20.35, 6.28 ± 1.06 vs 8.22 ± 1.58, 1.25 ± 0.21 vs 2.39 ± 0.46, 4.15 ± 0.86 vs 7.12 ± 1.01; week 2：85.35 ± 1Z32 vs 110.91 ± 18.93, 5.92 ±1.01 vs 8.31 ± 1.61, 1.09 ± 0.19 vs 2.28 ± 0.37, 4.105 ± 0.71 vs 7.08 ± 1.22; P 〈 0.05） were significantly lower in the observation group than in the control group. GCS scores at weeks 1 and 2 were significantly higher in the observation group than in the control group （12.08 ± 1.52 vs 10.28 ± 1.37, 13.26 ± 1.72 vs 11.31 ± 1.41, P 〈 0.05）. The hospitalization time, hospitalization cost, enteral nutrition time, and in-hospital mortality were significantly lower in the observation group than in thecontrol group （21.28 ± 7.16 vs 27.43 ± 8.23, 8.38 ± 1.96 vs 11.65 ± 2.67, 17.66 ± 5.71 vs 23.19 ± 7.33, 16.25% vs 28.57%, P 〈 0.05）. The GOS score at 6 mo after discharge was significantly higher in the observation group than in the control group （4.32 ± 1.25 vs 3.11 ±0.91, P 〈 0.05）. The early use of probiotics-con

关 键 词：颅脑损伤 肠内营养 益生菌 

分 类 号：R651.15[医药卫生—外科学]