强化早期肠内营养在预防重型颅脑损伤后患者免疫功能下降中的作用

目的研究强化早期肠内营养在预防重型颅脑损伤患者并发免疫力下降中的作用。方法将60例格拉斯哥昏迷评分（GCS）〉5～8分的重型颅脑损伤患者随机分为强化早期肠内营养组（观察组）和对照组，各30例，入院后48h内开始管饲肠内营养（观察组中额外添加精氨酸和谷氨酰胺），观察组和对照组等氮等热量营养支持，比较两组肠内营养第7、10天各患者的血糖、外周白细胞、CD4＋、CD4＋／CD8＋．免疫力状况及机体感染等情况。结果肠内营养第7、lO天．观察组血糖较对照组明显降低，外周淋巴细胞总数明显低于对照组，差异有统计学意义（P〈0．05），血液检查观察组和对照组的CD4＋、CD4＋／CD8＋比较，差异有统计学意义（P〈O．05），观察组患者免疫力增强，医院内感染发生率较对照组明显降低，差异有统计学意义（P〈0．05）。结论强化早期肠内营养在预防重型颅脑损伤患者免疫功能下降中作用显著．是重型颅脑外伤患者优先选择的营养途径。

Effect of enhanced early enteral nutrition on patients with decrease of immune function after severe traumatic brain injury

Objective To study the effect of enhanced early enteral nutrition （EEN） to prevent immunity decrease after severe traumatic brain injury. Methods A total of 60 patients with severe traumatic brain injuryGlasgow Coma Scale （GCS）5〈 GCS ≤ 8）were randomly divided into enhanced EEN group （the observation group） and the control group, 30 cases in each group. The eternal nutrition （EN） was fed on gavage within 48 h after admission （arginine and glutamine were only added in the observa- tion group）. The observation group and the control group were supported by equal nitrogen and energy, and the blood glucose, to- tal peripheral lymphoeytes, CD4＋, CD4＋/CD8＋, immune parameters, body infection and so on in the two groups were compared on 7th d and 10th d of EN respectively. Results The blood glucose and the total peripheral lymphocytes of the observation group on 7th d and 10th d of EN were significantly lower than those of the control group （P〈0.05）, and the difference of CD4＋, CD4＋/CD8＋ in the blood examination between the two groups was statistically significant （P〈0.05）. The immune function in the observation group was improved, while the nosocomial infection rate was obviously lower than that in the control group （P〈0.05）. Conclusion The enhanced EEN on patients with severe eraniocerebral injury plays a positive role in preventing deerease of immune func- tion, it is a preferential approach for the patients with severe traumatic brain injury.