肠内免疫营养对急性重型颅脑损伤患者免疫功能及预后的影响研究  

Effects of Immunomodulating Enteral Nutrition on the Immunologic Function and Prognosis of Patients with Acute Severe Craniocerebral Injury

作　　者：王白永[1] 林乐清[1] 唐文学[1] WANG Bai-yong;LIN Le-qing;TANG Wen-xue(ICU,the Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院重症医学科,浙江省杭州市310015

出　　处：《中国全科医学》2018年第5期531-534,共4页Chinese General Practice

基　　金：浙江省中医药科技计划项目(2016ZB103)

摘　　要：目的评价肠内免疫营养对急性重型颅脑损伤患者T淋巴细胞亚群、机械通气及预后的影响。方法选取2014年8月—2016年2月于杭州师范大学附属医院重症医学科治疗的急性重型颅脑损伤患者72例为研究对象。采用随机数字表法,将患者分为治疗组和对照组,各36例。治疗组、对照组分别给予肠内免疫营养制剂和等氮、等热量的匀浆支持治疗。记录两组机械通气时间及2周脱机成功率,于入院第1、7、14天检测T淋巴细胞各亚群分布,采用格拉斯哥预后量表评价患者6个月后神经功能。结果治疗组机械通气时间较对照组短,且2周内脱机成功率高于对照组(P<0.05)。入院第7、14天,治疗组CD_3^+、CD_4^+、CD_4^+/CD_8^+高于对照组(P<0.05)。6个月后,治疗组格拉斯哥预后量表评分优于对照组,平均分高于对照组(P<0.05)。结论急性重型颅脑损伤患者及时合理使用肠内免疫营养支持治疗,有助于改善机体免疫功能,缩短机械通气时间,提高脱机成功率,促进神经功能恢复。Objective To evaluate the effect of immunomodulating enteral nutrition on T-lymphocyte subset,mechanical ventilation and prognosis in patients with acute severe craniocerebral injury.Methods Seventy-two patients with acute severe craniocerebral injury treated in the ICU,the Affiliated Hospital of Hangzhou Normal University from August 2014 to February 2016 were selected as the subjects and randomly divided into the treatment group and the control group,with 36 in each.The treatment group received enteral nutritional emulsion(TPF-T),and the control group received homogenate(a kind of enteral nutritional suspension)with the same amount of nitrogen and calories contained in TPF-T given to the treatment group.The duration of mechanical ventilation,rate of successful weaning from mechanical ventilation within two weeks after treatment were recorded.T-lymphocyte subset were measured on the 1st,7th,14th days after admission.And the neurological function was evaluated by the Glasgow Outcome Score(GOS)at 6 months after treatment.Results The treatment group had shorter duration of mechanical ventilation and higher rate of successful weaning from mechanical ventilation within 2 weeks after treatment than the control group(P<0.05).On the 7th,14th days after admission,the levels of CD+3,CD+4 and CD+4/CD+8 were all significantly higher in the treatment group than in the control group(P<0.05).The overall GOS and average GOS assessed at 6 months after treatment were all better in the treatment group than in the control group(P<0.05).Conclusion The timely and reasonable immunomodulating enteral nutrition can improve the immune function,shorten the duration of mechanical ventilation,increase the rate of successful weaning from mechanical ventilation and promote the recovery of neurological function among the patients with acute severe craniocerebral injury.

关 键 词：颅脑损伤 肠内免疫营养 T淋巴细胞亚群 呼吸 人工 格拉斯哥预后评分 

分 类 号：R651[医药卫生—外科学]