早期小剂量肠内外营养联合免疫支持对高血压脑出血术后患者神经功能恢复的影响  

Effects of early using low-dose enteral and parenteral nutrition combined with immune support therapy on postoperative neurological function recovery in patients with hypertensive intracerebral hemorrhage

作　　者：施建芳 吴赛飞 王科[2] 吴爱文[1] Shi Jianfang;Wu Saifei;Wang Ke;Wu Aiwen(Department of Rehabilitation,Zhejiang Xiaoshan Hospital,Hangzhou 311200,Zhejiang,China;Department of Neurosurgery,Zhejiang Xiaoshan Hospital,Hangzhou 311200,Zhejiang,China)

机构地区：[1]浙江萧山医院康复科,浙江杭州311200 [2]浙江萧山医院神经外科,浙江杭州311200

出　　处：《中国中西医结合急救杂志》2021年第1期78-82,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的探讨早期小剂量肠内外营养联合免疫支持对高血压脑出血术后患者营养、免疫和神经功能恢复的影响.方法采用前瞻性研究方法,选择2018年1月至12月浙江萧山医院收治的168例高血压脑出血术后患者作为研究对象,分为肠内营养(EN)组(术后给予EN)、EN+补充性肠外营养(SPN)组(给予小剂量EN+SPN联合支持)以及免疫支持组(在EN+SPN组基础上加用谷氨酰胺),每组56例.于营养支持首日及2周时测定3组的营养指标〔总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)、转铁蛋白(TRF)、肌酐身高指数(CHI)、三头肌皮褶厚度〕、免疫指标〔免疫球蛋白(IgA、IgG、IgM)、CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)比值〕、美国国立卫生研究院卒中量表(NIHSS)评分,比较胃肠道和感染相关并发症发生率.结果①营养指标:营养支持2周时3组ALB、PA、Hb、CHI、三头肌皮褶厚度均较首日升高,其中EN+SPN组和免疫支持组均明显高于EN组,免疫支持组升高最明显〔ALB(g/L):47.11±4.62比44.02±3.79、40.96±4.55,PA(mg/L):248.45±20.65比239.42±18.43、226.02±15.79,Hb(g/L):168.02±4.26比155.26±5.01、150.04±4.79,CHI:(79.02±5.41)%比(76.49±4.79)%、(70.23±5.74)%,三头肌皮褶厚度(mm):8.58±0.22比8.41±0.11、8.27±0.09,均P<0.05〕;②免疫指标:营养支持2周时3组IgA、IgG、IgM、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)比值均高于首日,其中EN+SPN组和免疫支持组均明显高于EN组,免疫支持组升高最明显〔IgA(g/L):2.71±0.34比2.50±0.25、2.39±0.21,IgG(g/L):10.73±0.32比10.17±0.34、9.82±0.32,IgM(g/L):1.36±0.14比1.30±0.09、1.26±0.07,CD3^(+):(56.01±2.98)%比(54.02±0.76)%、(53.93±1.97)%,CD4^(+):(36.74±5.01)%比(33.02±4.79)%、(28.12±4.01)%,CD4^(+)/CD8^(+)比值:1.47±0.13比1.39±0.11、1.32±0.12,均P<0.05〕;③NIHSS评分:营养支持2周时3组NIHSS评分均较首日降低,其中EN+SPN组和免疫支持组均明显低于EN组,以免疫支持组降低最明显(分:26.78±4.66比3Objective To explore the effects of early using low-dose enteral and parenteral nutrition combined with immune support therapy on nutritional status,immune and neurological function recovery in postoperative patients with hypertensive intra-cerebral hemorrhage.Methods Using prospective research method,168 postoperative patients with hypertensive intra-cerebral hemorrhage admitted in Zhejiang Xiaoshan Hospital from January 2018 to December 2018 were selected as research objects,and they were divided into 3 groups:enteral nutrition support(EN)group(given EN after operation),EN+supplementary parenteral nutrition(SPN)group(given combined support of low-dose EN+SPN)and immune support group(based on EN+SPN group,glutamine added),with 56 cases in each group.On day 1 and 2 weeks after nutritional support,the nutritional indicators[total protein(TP),hemoglobin(Hb),albumin(ALB),pre-iilbumin(PA),transferrin(TRF),creatinine height index(CHI)and triceps skin-fold thickness],immune indexes[immunoglobulin(IgG,IgA,IgM),CD3^(+),GD4^(+),CD4^(+)/CD84!and National Institute of Health Stroke Scale(NIHSS)in three groups were measured,and the incidence of gastrointestinal and infection-related complications was compared among 3 groups.Results①After 2 weeks of nutritional support,the nutritional indexes ALB,PA,Hb,CHI and triceps skinfold thickness were higher than those on day 1 in the three groups,the indexes in EN+SPN and immune support groups were significantly higher than those in EN group,and immune support group had the most obvious increase[ALB(g/L):47.11±4.62 vs.44.02±3.79,40.96±4.55,PA(mg/L):248.45±20.65 vs.239.42±18.43,226.02±15.79,Hb(g/L):168.02±4.26 vs.155.26±5.01,150.04±4.79,CHI:(79.02±5.41)%vs.(76.49±4.79)%,(70.23±5.74)%,triceps skinfold thickness(mm):8.58^(+)0.22 vs.8.41+0.11,8,27±0.09,all P<0.05];②After 2 weeks of nutritional support,the immune index levels of IgA,IgG,IgM,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)were markedly higher than those on day 1 in three groups,the indexes of EN+SPN and immune support gr

关 键 词：高血压脑出血 肠内营养 肠外营养 免疫 

分 类 号：R73[医药卫生—肿瘤]