不同时机营养支持对重型颅脑损伤患者营养状态、免疫功能及临床预后的影响  

Effects of different timing of nutritional support on nutritional status,immune function and clinical prognosis of patients with severe craniocerebral injury

作　　者：郑亚东[1] 李家兰[2] 高英[3] 黄警锐[1] 陈颖 万晓强[5] ZHENG Yadong;LI Jialan;GAO Ying;HUANG Jingrui;CHEN Ying;WAN Xiaoqiang(Department of Neurosurgery,Chongqing Municipal Emergency Medical Center,Chongqing 400014,China;Department of Emergency,Chongqing Municipal Emergency Medical Center,Chongqing 400014,China;Department of Nursing,Chongqing Municipal Emergency Medical Center,Chongqing 400014,China;Department of Neurosurgery,Army Special Medical Center of the Chinese People′s Liberation Army,Chongqing 400042,China;Department of Gastroenterology,Chongqing Municipal Emergency Medical Center,Chongqing 400014,China)

机构地区：[1]重庆市急救医疗中心神经外科,400014 [2]重庆市急救医疗中心急诊科,400014 [3]重庆市急救医疗中心护理部,400014 [4]中国人民解放军陆军特色医学中心神经外科,400042 [5]重庆市急救医疗中心消化科,400014

出　　处：《重庆医学》2022年第10期1691-1695,共5页Chongqing medicine

基　　金：2017年医学科研计划重点项目(2017ZDXM024)。

摘　　要：目的分析不同时机营养支持对重型颅脑损伤患者急性生理与慢性健康状态(APACHE)Ⅱ评分、营养指标、红细胞分布宽度(RDW)及免疫功能的影响。方法选取重庆市急救医疗中心2017年8月至2019年3月收治的68例重型颅脑损伤患者作为研究对象,其中入院12 h内进行营养支持者40例(早期组),入院48 h后进行营养支持者28例(延迟组)。观察并记录两组患者入院时和入院1周后的APACHEⅡ评分、微型营养评分(MNA)、营养指标[总蛋白(TP)、清蛋白(ALB)、血红蛋白(Hb)]、RDW、免疫功能指标(体液免疫指标IgG、IgA、IgM及T淋巴细胞亚群指标CD4、CD8、CD4/CD8)、并发症发生情况、急性胃黏膜损害发生率和病死率,然后进行统计学分析。结果早期组患者入院1周后的MNA、APACHEⅡ评分和RDW均明显优于延迟组(P<0.05);入院1周后,与延迟组比较,早期组患者的TP、ALB和Hb水平更高(P<0.05),IgG、IgA、IgM、CD4、CD8、CD4/CD8水平更低(P<0.05);早期组患者腹泻、腹胀和呕吐发生率明显低于延迟组,半年内急性胃黏膜损害发生率和病死率均更低,差异均有统计学意义(P<0.05)。结论对重型颅脑损伤患者实施早期营养支持可以有效降低患者APACHEⅡ评分,改善营养状况和免疫功能,缩小RDW,减少并发症,对改善患者预后有重要意义。Objective To analyze the effects of different timing of nutritional support on acute physiology and chronic health evaluation(APACHE)Ⅱscores,nutrition indicators,red blood cell distribution width(RDW)and immune function in the patients with severe craniocerebral injury.Methods Sixty-eight patients with severe craniocerebral injury treated in Chongqing Municipal Emergency Medical Center from August 2017 to March 2019 were selected as the research subjects.Among them,40 cases received the nutrition support within 12 h of admission(early stage group),and 28 cases received the nutrition support within 48 h of admission(delay group).The APACHEⅡscore,mini nutritional assessment(MNA),nutrition indexes[total protein(TP),albumin(ALB),hemoglobin(Hb)],RDW,immune function indicators(humoral immunity indicators IgG,IgA,IgM and T lymphocyte subgroup indicators CD4,CD8,CD4/CD8),complications,incidence rate of acute gastric mucosal damage and mortality rate,were observed and recorded in the two groups.Then statistical analysis was performed.Results The MNA,APACHEⅡscore and RDW of the early stage group were significantly better than those of the delay group(P<0.05);In one week after admission,the TP,ALB and Hb levels in the early group were higher compared with the delay group(P<0.05),the levels of IgG,IgA,IgM,CD4,CD8,CD4/CD8 were lower(P<0.05);the incidence rates of diarrhea,abdominal distension and vomiting in the early group were significantly lower than those in the delay group,and the incidence rate of acute gastric mucosal injury and mortality rate within six months were lower,and the differences were statistical significant(P<0.05).Conclusion Implementing the early nutritional support for the patients with severe craniocerebral injury can effectively reduce the APACHEⅡscore,improve the nutritional status and immune function,reduce the width of red blood cell distribution,and reduce complications,which is of great significance for improving the prognosis of the patients.

关 键 词：重型颅脑损伤 营养支持 APACHEⅡ评分 红细胞分布宽度 免疫功能 

分 类 号：R651.15[医药卫生—外科学]