黄芪联合肠内营养对重型颅脑损伤患者免疫功能和营养代谢的影响

目的研究黄芪联合肠内营养对重型颅脑损伤患者免疫功能及营养代谢的影响。方法60例重型颅脑损伤患者随机均分为实验组和对照组,实验组尽早(48～72h)予改良匀浆膳加黄芪水煎液(相当于生药60g)治疗,对照组予肠内高营养多聚合剂(商品名能全力)治疗,不足部分由肠外营养补充,共20d。两组营养治疗前、后均测定IgA、IgG、IgM及T细胞亚群,同时监测空腹血糖(FBG)、白蛋白(ALB)、转铁蛋白(TF)、血红蛋白(Hb)及氮平衡(NB)等营养代谢指标。结果实验组治疗后IgG、CD4及CD4/CD8比值均较治疗前显著升高(P值分别<0.05、0.01),且均显著高于对照组治疗后水平(P值分别<0.05、0.01)。对照组治疗前、后IgG、IgM、IgA、CD4、CD8及CD4/CD8比值的差异均无统计学意义(P值均>0.05)。实验组治疗后FBG显著降低(P<0.01),ALB和TF显著升高(P值均<0.01),负氮平衡转为正氮平衡(P<0.01);以上各指标与对照组治疗后的差异均有统计学意义(P值均<0.01)。对照组治疗前、后的FBG、ALB、TF、Hb和NB的差异均无统计学意义(P值均>0.05)。结论黄芪联合肠内营养可明显改善重型颅脑损伤患者的免疫功能、血糖及蛋白质营养代谢。

Effect of Astragalus combined with enteral nutrition on immune function and nutritional metabolism in patients with severe brain injury

Objective To study the effect of Astragalus combined with enteral nutrition on immune function and nutritional metabolism in patients with severe brain injury.Methods Sixty patients with severe brain injury were randomly divided into experimental group and control group.The experimental group was given homogenized diet via enteral nutrition and Radix Astragalis(equivalent to 60g crude drug)at an early stage(48-72h);the control group was given Nutrisonfibre(Nutrieia)via enteral nutrition and parenteral nutrition,was given when needed.Blood samples were collected from both groups before and after nutritional treatment to determine IgA, IgG,IgM,and T-lymphocyte subsets;meanwhile,the fasting blood glucose,serum protein,and nitrogen balance were also measured.Results IgG,CD_4(%),and CD_4/CD_8 ratio in the experimental group after treatment were significantly higher than that before treatment and that in the control group(P<0.05 or 0.01).IgG,IgM,IgA, CD_4,CD_8 and CD_4/CD_8 had no significant changes in the control group before and after treatment.After treatment,the fasting blood glucose in the experimental group was significantly decreased(P<0.01),ALB and TF were significantly increased(all P<0.01);the nitrogen balance became positive;the above parameters were also significantly different between the 2 groups(all P<0.01).FBG,ALB,TF,Hb and NB had no significant changes before and after treatment in the control group.Conclusion Astragalus combined with enteral nutrition can obviously improve the immune function,blood glucose and protein metabolism in patients with severe brain injury.