老年重症高血压脑出血患者肠外营养介入时机探讨
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摘要
目的:探讨老年重症高血压脑出血(HIH)患者肠外营养(PN)的介入时机。方法:120例HIH患者,随机分为A(早期肠内营养组, EN组)、B组(早期肠内营养+24～48h肠外营养组)及C组(早期肠内营养+5～7d肠外营养组)3组,每组40例。比较观察各组胃肠道反应,并通过检测患者血二胺氧化酶(DAO)及血内毒素(ET)水平,观察不同营养方式对患者肠道屏障的影响;检测患者血清蛋白水平。结果:C组患者住院时间较A组、B组显著减少[12.18±2.02 vs 20.48±5.67、19.60±6.60 d,P<0.05];B组患者的感染及胆汁淤积发生率显著高于A、C组[6例(15.00%)vs 3例(7.50%)、2例(5.00%),P<0.05],但低血糖的发生率显著低于A、C组[2例(5.00%)vs 5例(12.50%)、5例(12.50%),P<0.05]。与A组比较,治疗第14d,B、C组患者血清前白蛋白及视黄醇结合蛋白水平均显著升高(P<0.05)。此外,以检出血清内毒素水平≥0.1EU/ml为阳性,治疗第14d A、B、C组患者中阳性的比例分别为4(10.00%)、5(12.50%)和1(2.50%),C组低于A、B组,差异有统计学意义(P<0.05)。结论:对于存在营养风险的老年重症HIH患者,在早期EN的基础上,联合延迟(5～7d)肠外营养的治疗策略,较单纯EN、EN+早期PN更有利于改善患者的营养指标及免疫功能,感染更少、恢复更快。
Objective: To explore the timing of intervention for parenteral nutrition(PN) in elderly patients with severe hypertensive intracerebral hemorrhage(HIH). Methods: 120 patients with HIH were randomly divided into 3 groups, group A(early enteral nutrition group,EN group), group B(early enteral nutrition+24～48 h parenteral nutrition group) and group C(early enteral nutrition+5～7 d parenteral nutrition group), with 40 cases in each group. The effects of diamine oxidase(DAO) and blood endotoxin on the intestinal barrier of the patients were observed and the serum albumin were detected. Results: The time of hospitalization in group C was significantly lower than that in group A and group B, [12.18±2.02 vs 20.48±5.67, 19.60±6.60 d, P<0.05], the incidence of infection and cholestasis in B group was significantly higher than group A, group C [6 cases(15%) vs 3 cases(7.50%), 2 cases(5%)], but the incidence of hypoglycemia was significantly lower than that of those [2 cases(5%) vs 5 cases(12.50%), 5 cases(12.50%), P<0.05]. Compared with group A, the levels of serum prealbumin and retinol binding protein on the 14 d, B and C groups increased significantly(P<0.05). In addition, that serum endotoxin level(≥0.1 EU/ml) was positive, the positive proportion in group A, B and C on the 14 d was 4(10%), 5(12.50%) and 1(2.50%), the positive proportion in group C was lower than that of in A and B group, the difference was statistically significant(P<0.05). Conclusion: For the elderly patients with severe HIH and nutritional risk, on the basis of early EN, the treatment strategy of combined delayed(5～7 d) parenteral nutrition is more beneficial to improve the nutritional index and immune function of the patients than the simple EN and EN+ early PN, with less infection and faster recovery.
Objective: To explore the timing of intervention for parenteral nutrition(PN) in elderly patients with severe hypertensive intracerebral hemorrhage(HIH). Methods: 120 patients with HIH were randomly divided into 3 groups, group A(early enteral nutrition group,EN group), group B(early enteral nutrition+24～48 h parenteral nutrition group) and group C(early enteral nutrition+5～7 d parenteral nutrition group), with 40 cases in each group. The effects of diamine oxidase(DAO) and blood endotoxin on the intestinal barrier of the patients were observed and the serum albumin were detected. Results: The time of hospitalization in group C was significantly lower than that in group A and group B, [12.18±2.02 vs 20.48±5.67, 19.60±6.60 d, P<0.05], the incidence of infection and cholestasis in B group was significantly higher than group A, group C [6 cases(15%) vs 3 cases(7.50%), 2 cases(5%)], but the incidence of hypoglycemia was significantly lower than that of those [2 cases(5%) vs 5 cases(12.50%), 5 cases(12.50%), P<0.05]. Compared with group A, the levels of serum prealbumin and retinol binding protein on the 14 d, B and C groups increased significantly(P<0.05). In addition, that serum endotoxin level(≥0.1 EU/ml) was positive, the positive proportion in group A, B and C on the 14 d was 4(10%), 5(12.50%) and 1(2.50%), the positive proportion in group C was lower than that of in A and B group, the difference was statistically significant(P<0.05). Conclusion: For the elderly patients with severe HIH and nutritional risk, on the basis of early EN, the treatment strategy of combined delayed(5～7 d) parenteral nutrition is more beneficial to improve the nutritional index and immune function of the patients than the simple EN and EN+ early PN, with less infection and faster recovery.
引文
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2 Food Trial Collaboration.Poor Nutritional Status on Admission Predicts Poor Outcomes after Stroke:Observational Data from the FOOD Trial.Stroke,2003,34(6):1450～1456.
3 Dhaliwal R,Cahill N,Lemieux M,et al.The Canadian Critical Care Nutrition Guidelines in 2013:An Update on Current Recommendations and Implementation Strategies.Nutrition in Clinical Practice,2014,29(1):29～43.
4 杨春祥,王爱萍.重症高血压脑出血早期营养支持的临床价值分析.现代诊断与治疗,2013,24(5):19～20.
5 朱林.消化道肿瘤患者术后早期肠内营养联合肠外营养支持的疗效分析.中国社区医师,2018,34(7):28～29.
6 梁吉振,任云,宫心明.早期肠内营养联合肠外营养对食管癌患者术后营养状况及生活质量的影响.安徽医学,2018,39(1):110～112.
7 章莉.早期肠内免疫微生态营养联合低氮肠外营养对治疗重症急性胰腺炎免疫、炎症及机体预后的影响.哈尔滨医药,2017,37(6):524～525;528.
8 龙晓静,孙德强,曾英,等.食管癌术后早期肠内营养联合肠外营养与全肠外营养支持的临床疗效比较.中国医药导报,2016,13(5):126～129.
2 Food Trial Collaboration.Poor Nutritional Status on Admission Predicts Poor Outcomes after Stroke:Observational Data from the FOOD Trial.Stroke,2003,34(6):1450～1456.
3 Dhaliwal R,Cahill N,Lemieux M,et al.The Canadian Critical Care Nutrition Guidelines in 2013:An Update on Current Recommendations and Implementation Strategies.Nutrition in Clinical Practice,2014,29(1):29～43.
4 杨春祥,王爱萍.重症高血压脑出血早期营养支持的临床价值分析.现代诊断与治疗,2013,24(5):19～20.
5 朱林.消化道肿瘤患者术后早期肠内营养联合肠外营养支持的疗效分析.中国社区医师,2018,34(7):28～29.
6 梁吉振,任云,宫心明.早期肠内营养联合肠外营养对食管癌患者术后营养状况及生活质量的影响.安徽医学,2018,39(1):110～112.
7 章莉.早期肠内免疫微生态营养联合低氮肠外营养对治疗重症急性胰腺炎免疫、炎症及机体预后的影响.哈尔滨医药,2017,37(6):524～525;528.
8 龙晓静,孙德强,曾英,等.食管癌术后早期肠内营养联合肠外营养与全肠外营养支持的临床疗效比较.中国医药导报,2016,13(5):126～129.