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
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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 ± 17.32 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). CONCLUSION The early use of probiotics-containing enteral nutrition regimens in patients with SCCI can significantly improve nutritional status, reduce inflammatory response, and improve GCS score.
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 ± 17.32 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). CONCLUSION The early use of probiotics-containing enteral nutrition regimens in patients with SCCI can significantly improve nutritional status, reduce inflammatory response, and improve GCS score.
引文
1孙敬伟,赵振林,黄富,刘康峰,肖华.影响重型颅脑损伤患者预后的临床因素分析.中华神经医学杂志2016;15:279-283[DOI:10.3760/cma.j.issn.1671-8925.2016.03.012]
2栾雷.重型颅脑损伤标准大骨瓣开颅术患者围术期炎性应激及代谢状态的变化.海南医学院学报2016;22:1541-1543[DOI:10.13210/j.cnki.jhmu.20160408.004]
3王耿焕,沈和平,褚正民,沈建国,张李涛.神经外科重症监护室重型颅脑损伤患者医院感染的影响因素分析.中华神经外科杂志2016;32:405-408[DOI:10.3760/cma.j.issn.1001-2346.2016.04.020]
4刘丽燕,王兴鹏,曾悦.益生菌在急性胰腺炎治疗中的应用.中华胰腺病杂志2016;16:417-421[DOI:10.3760/cma.j.issn.1674-1935.2016.06.016]
5王洪生,孟文博,王鹏,程月飞,王志明,赵佩林,殷尚炯.重型颅脑损伤临床救治体会(附662例报道).中华神经创伤外科电子杂志2017;3:68-71[DOI:10.3877/cma.j.issn.2095-9141.2017.02.002]
6吴春涛,王凤安.早期肠内营养在重型颅脑损伤患者急性胃肠损伤中的应用.中华临床营养杂志2016;24:274-277[DOI:10.3760/cma.j.issn.1674-635X.2016.05.004]
7徐可,杨建军.颅脑损伤后脑水肿的发病机制及研究进展.中华脑科疾病与康复杂志(电子版)2015;11:184-187[DOI:10.3877/cma.j.issn.2095-123X.2015.03.009]
8李巧霞.结构脂肪乳在重型颅脑损伤患者中的应用研究.中华危重症医学杂志(电子版)2014;7:32-34[DOI:10.3877/cma.j.issn.1674-6880.2014.04.008]
9陈建时,郭蕾,潘利伟,郭献阳,张弩,程碧环,金胜威,应斌宇.长时程亚低温疗法对急性重型颅脑损伤患者免疫功能的影响.中华神经外科杂志2016;32:574-578[DOI:10.3760/cma.j.issn.1001-2346.2016.06.010]
10包龙,徐峰,凌伟华,丁礼.创伤性颅脑损伤患者:急性胃肠损伤与营养支持-基于欧洲危重病医学会关于急性胃肠损伤定义及处理指南的思考.中国急救医学2013;33:793-796[DOI:10.3969/j.issn.1002-1949.2013.9.007]
11 Carney N,Totten AM,O’Reilly C,Ullman JS,Hawryluk GW,Bell MJ,Bratton SL,Chesnut R,Harris OA,Kissoon N,Rubiano AM,Shutter L,Tasker RC,Vavilala MS,Wilberger J,Wright DW,Ghajar J.Guidelines for the Management of Severe Traumatic Brain Injury,Fourth Edition.Neurosurgery 2017;80:6-15[PMID:27654000 DOI:10.1227/NEU.0000000000001432]
12 Aadal L,Mortensen J,Nielsen JF.Weight reduction after severe brain injury:a challenge during the rehabilitation course.J Neurosci Nurs 2015;47:85-90[PMID:25700193 DOI:10.1097/JNN.0000000000000121]
13刘军,吴允孚.危重病相关免疫功能障碍.中华急诊医学杂志2015;24:918-921[DOI:10.3760/cma.j.issn.1671-0282.2015.08.028]
14朋传喜,张彬.早期胃肠营养在神经外科术后重症患者治疗中的应用.安徽医药,2016;20:744-746[DOI:10.3969/j.issn.1009-6469.2016.04.037]
15赵永华,杨开敏,贾秀艳,晁怀宇,孟伟.早期应用含膳食纤维的肠内营养与全肠外营养对重型颅脑损伤患者肠黏膜屏障的影响比较.实用医学杂志2013;29:3508-3510[DOI:10.3969/j.issn.1006-5725.2013.21.023]
16陈玮,李尧,王芬芬,张宇,傅宏媛.低热量肠内营养对急性期重型创伤性脑损伤患者的疗效.中华创伤杂志2016;32:124-127[DOI:10.3760/cma.j.issn.1001-8050.2016.02.007]
17刘军.全身性感染免疫功能监测研究进展.中华医学杂志2017;97:1677-1680[DOI:10.3760/cma.j.issn.0376-2491.2017.21.018]
18侯哲,郭瑞,苏宏超,马红双.早期肠内益生菌营养与丙氨酰谷氨酰胺对重症外伤合并颅脑损伤患者预后的影响.中国实用神经疾病杂志2016;19:25-27[DOI:10.3969/j.issn.1673-5110.2016.18.015]
19王翠娥,陈祥荣,朱蓉蓉,刘金霞,黄丽娜,胡伟鹏.鼻肠管与鼻胃管肠内营养对重型颅脑损伤患者预后和并发症、炎症反应和肠黏膜屏障功能的影响.中华神经医学杂志2017;16:599-603[DOI:10.3760/cma.j.issn.1671-8925.2017.06.012]
20 Horn SD,Kinikini M,Moore LW,Hammond FM,Brandstater ME,Smout RJ,Barrett RS.Enteral Nutrition for Patients With Traumatic Brain Injury in the Rehabilitation Setting:Associations With Patient Preinjury and Injury Characteristics and Outcomes.Arch Phys Med Rehabil2015;96:S245-S255[PMID:26212401 DOI:10.1016/j.apmr.2014.06.024]
2栾雷.重型颅脑损伤标准大骨瓣开颅术患者围术期炎性应激及代谢状态的变化.海南医学院学报2016;22:1541-1543[DOI:10.13210/j.cnki.jhmu.20160408.004]
3王耿焕,沈和平,褚正民,沈建国,张李涛.神经外科重症监护室重型颅脑损伤患者医院感染的影响因素分析.中华神经外科杂志2016;32:405-408[DOI:10.3760/cma.j.issn.1001-2346.2016.04.020]
4刘丽燕,王兴鹏,曾悦.益生菌在急性胰腺炎治疗中的应用.中华胰腺病杂志2016;16:417-421[DOI:10.3760/cma.j.issn.1674-1935.2016.06.016]
5王洪生,孟文博,王鹏,程月飞,王志明,赵佩林,殷尚炯.重型颅脑损伤临床救治体会(附662例报道).中华神经创伤外科电子杂志2017;3:68-71[DOI:10.3877/cma.j.issn.2095-9141.2017.02.002]
6吴春涛,王凤安.早期肠内营养在重型颅脑损伤患者急性胃肠损伤中的应用.中华临床营养杂志2016;24:274-277[DOI:10.3760/cma.j.issn.1674-635X.2016.05.004]
7徐可,杨建军.颅脑损伤后脑水肿的发病机制及研究进展.中华脑科疾病与康复杂志(电子版)2015;11:184-187[DOI:10.3877/cma.j.issn.2095-123X.2015.03.009]
8李巧霞.结构脂肪乳在重型颅脑损伤患者中的应用研究.中华危重症医学杂志(电子版)2014;7:32-34[DOI:10.3877/cma.j.issn.1674-6880.2014.04.008]
9陈建时,郭蕾,潘利伟,郭献阳,张弩,程碧环,金胜威,应斌宇.长时程亚低温疗法对急性重型颅脑损伤患者免疫功能的影响.中华神经外科杂志2016;32:574-578[DOI:10.3760/cma.j.issn.1001-2346.2016.06.010]
10包龙,徐峰,凌伟华,丁礼.创伤性颅脑损伤患者:急性胃肠损伤与营养支持-基于欧洲危重病医学会关于急性胃肠损伤定义及处理指南的思考.中国急救医学2013;33:793-796[DOI:10.3969/j.issn.1002-1949.2013.9.007]
11 Carney N,Totten AM,O’Reilly C,Ullman JS,Hawryluk GW,Bell MJ,Bratton SL,Chesnut R,Harris OA,Kissoon N,Rubiano AM,Shutter L,Tasker RC,Vavilala MS,Wilberger J,Wright DW,Ghajar J.Guidelines for the Management of Severe Traumatic Brain Injury,Fourth Edition.Neurosurgery 2017;80:6-15[PMID:27654000 DOI:10.1227/NEU.0000000000001432]
12 Aadal L,Mortensen J,Nielsen JF.Weight reduction after severe brain injury:a challenge during the rehabilitation course.J Neurosci Nurs 2015;47:85-90[PMID:25700193 DOI:10.1097/JNN.0000000000000121]
13刘军,吴允孚.危重病相关免疫功能障碍.中华急诊医学杂志2015;24:918-921[DOI:10.3760/cma.j.issn.1671-0282.2015.08.028]
14朋传喜,张彬.早期胃肠营养在神经外科术后重症患者治疗中的应用.安徽医药,2016;20:744-746[DOI:10.3969/j.issn.1009-6469.2016.04.037]
15赵永华,杨开敏,贾秀艳,晁怀宇,孟伟.早期应用含膳食纤维的肠内营养与全肠外营养对重型颅脑损伤患者肠黏膜屏障的影响比较.实用医学杂志2013;29:3508-3510[DOI:10.3969/j.issn.1006-5725.2013.21.023]
16陈玮,李尧,王芬芬,张宇,傅宏媛.低热量肠内营养对急性期重型创伤性脑损伤患者的疗效.中华创伤杂志2016;32:124-127[DOI:10.3760/cma.j.issn.1001-8050.2016.02.007]
17刘军.全身性感染免疫功能监测研究进展.中华医学杂志2017;97:1677-1680[DOI:10.3760/cma.j.issn.0376-2491.2017.21.018]
18侯哲,郭瑞,苏宏超,马红双.早期肠内益生菌营养与丙氨酰谷氨酰胺对重症外伤合并颅脑损伤患者预后的影响.中国实用神经疾病杂志2016;19:25-27[DOI:10.3969/j.issn.1673-5110.2016.18.015]
19王翠娥,陈祥荣,朱蓉蓉,刘金霞,黄丽娜,胡伟鹏.鼻肠管与鼻胃管肠内营养对重型颅脑损伤患者预后和并发症、炎症反应和肠黏膜屏障功能的影响.中华神经医学杂志2017;16:599-603[DOI:10.3760/cma.j.issn.1671-8925.2017.06.012]
20 Horn SD,Kinikini M,Moore LW,Hammond FM,Brandstater ME,Smout RJ,Barrett RS.Enteral Nutrition for Patients With Traumatic Brain Injury in the Rehabilitation Setting:Associations With Patient Preinjury and Injury Characteristics and Outcomes.Arch Phys Med Rehabil2015;96:S245-S255[PMID:26212401 DOI:10.1016/j.apmr.2014.06.024]