不同肠内营养启动时间对重型颅脑损伤患者营养状况并发症和免疫功能的影响  

Effect of different enteral nutrition initiation time on nutritional status,complications and immune function in patients with severe craniocerebral injury

作　　者：袁洁 季翠玲 汤丽丽 张静 YUAN Jie;JI Cuiling;TANG Lili;ZHANG Jing(Nanjing Drum Tower Hospital,Nanjing 210003,China)

机构地区：[1]南京鼓楼医院,江苏南京210003

出　　处：《中国实用神经疾病杂志》2024年第11期1332-1336,共5页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探究不同肠内营养启动时间对重型颅脑损伤(sTBI)患者营养状况、并发症和免疫功能的影响。方法选取2022-01—2023-05南京鼓楼医院收治的100例sTBI患者为研究对象,随机数字表法分为早期组和延迟组各50例。早期组在发病后24 h内启动肠内营养干预,延迟组在发病后24~48 h内启动肠内营养干预。比较2组干预前、干预后(肠内营养干预14 d时)血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TF)水平及血浆免疫球蛋白IgA、IgM、IgG水平,并收集2组并发症发生情况。结果早期组干预后血清ALB、PA、TF水平均明显高于延迟组[ALB:(40.68±4.83)g/L比(39.29±5.02)g/L;PA:(265.86±23.74)mg/L比(246.48±27.65)mg/L;TF:(3.17±0.69)g/L比(3.04±0.46)g/L,P<0.05]。早期组干预后血浆IgA、IgG水平均明显高于延迟组[IgA:(2.73±0.75)g/L比(1.86±0.57)g/L;IgG:(10.76±3.12)g/L比(7.46±2.15)g/L,P<0.05]。2组患者IgM水平[(0.88±0.29)g/L比(0.78±0.26)g/L]比较差异无统计学意义(P>0.05)。早期组非吸入性肺炎、应激性溃疡发生率明显低于延迟组(非吸入性肺炎:56.00%比78.00%;应激性溃疡:4.00%比16.00%,P<0.05)。结论早期启动肠内营养比延迟启动可更显著的改善sTBI患者营养状况和免疫功能,并可减少非吸入性肺炎、应激性溃疡等并发症的发生。Objective To investigate the effect of different enteral nutrition start-up time on nutritional status,complications and immune function in patients with severe traumatic brain injury(sTBI).Methods A total of 100 patients with sTBI admitted to Nanjing Drum Tower Hospital from January 2022 to May 2023 were selected as the research objects.They were randomly divided into early group and delayed group,50 cases in each group.The early group started enteral nutrition intervention within 24 hours after onset,and the delayed group started enteral nutrition intervention within 24-48 hours after onset.The levels of serum albumin(ALB),prealbumin(PA),transferrin(TF)and plasma immunoglobulin IgA,IgM,IgG were compared between the two groups before and after intervention(14 days after enteral nutrition intervention),and the occurrence of complications in the two groups was collected.Results The levels of serum ALB,PA and TF in the early group were significantly higher than those in the delayed group(ALB:(40.68±4.83)g/L vs(39.29±5.02)g/L;PA:(265.86±23.74)mg/L vs(246.48±27.65)mg/L;TF:(3.17±0.69)g/L vs(3.04±0.46)g/L,P<0.05).The levels of plasma IgA and IgG in the early group were significantly higher than those in the delayed group(IgA:(2.73±0.75)g/L vs(1.86±0.57)g/L;IgG:(10.76±3.12)g/L vs(7.46±2.15)g/L,P<0.05).There was no significant difference in IgM level between the two groups((0.88±0.29)g/L vs(0.78±0.26)g/L,P>0.05).The incidence of non-inhalation pneumonia and stress ulcer in the early group was significantly lower than that in the delayed group(non-inhalation pneumonia:56.00%vs 78.00%;stress ulcer:4.00%vs 16.00%,P<0.05).Conclusion Early initiation of enteral nutrition can more significantly improve the nutritional status and immune function of sTBI patients than delayed initiation,and can reduce the incidence of complications,such as non-inhalation pneumonia and stress ulcer.

关 键 词：肠内营养 重型颅脑损伤 营养状况 免疫功能 并发症 

分 类 号：R651.15[医药卫生—外科学]