早期肠内营养联合合生元制剂对重型颅脑损伤病人肠道菌群及SIgA的影响

目的]观察早期肠内营养联合合生元制剂对重型颅脑损伤病人肠道主要正常菌群（大肠杆菌、肠球菌、双歧杆菌、乳酸杆菌、类杆菌和梭菌）、粪便分泌型IgA（SIgA）和感染性并发症的影响。方法]将49例重型颅脑损伤病人随机分为两组,对照组24例,研究组25例;对照组于伤后24h～48h内采用肠内营养制剂（瑞素）开始营养支持;研究组在对照组的基础上,在肠内营养支持的前14d联合合生元制剂（金双歧）。在肠内营养支持0d、4d、8d和15d分别采集粪便标本进行肠道主要正常菌群定量分析和采用酶联免疫吸附法测定粪便SIgA。观察研究期间两组病人感染性并发症的差异。结果]在肠内营养支持8d和15d,研究组大肠杆菌和肠球菌低于对照组（P〈0.05或P〈0.01）,双歧杆菌和乳酸杆菌高于对照组（P〈0.01）;类杆菌和梭菌组间比较均无统计学意义（P〉0.05）。在肠内营养支持8d和15d研究组大便SIgA含量高于对照组（P〈0.05）;研究组术后的感染性并发症发生率低于对照组（33.33%比50.00%）,但差异无统计学意义（P〉0.05）。结论]与普通早期肠内营养比较,早期肠内营养联合合生元制剂可有效改善重型颅脑损伤病人肠道菌群失衡,上调肠道局部免疫功能。

Influence of early enteral nutrition combined with synbiotics agents on intestinal flora and SIgA of patients with severe craniocerebral injury

Objective：To investigate the influence of early enteral nutrition combined with synbiotics agents on main normal intestinal flora including escherichia coli,enterococcus,bifidobacterium,lactobacillus,bacteroides and clostridium,SIgA in the stools and infected complications of patients with severe craniocerebral injury.Methods：A total of 49 patients with severe craniocerebral injury were randomly divided into control group （n=24） and test group （n=25）.Patients in control group started receiving enteral nutrition （RuiSu） within 24 to 48 hours after injury.Patients in test group received an enteral nutritional support as in control group,but added with synbiotics （bifidobacterium） in the first 14 days of enteral nutritional support.Stool specimens of all cases were collected on day 0,day 4,day 8,day 15 of enteral nutrition support for quantitative analysis of normal intestinal flora and detection of stool SIgA through enzyme-linked immunosorbent assay.And differences of infectious complications between the two group cases had been observed.Results：On the 8th day and the 15th day of nutritional support,escherichia coli and enterococcus expression in test group cases were lower than that of control group cases.And bifidobacteria and lactobacillus expression in test group cases were higher than that of control group cases.There were statistical significant differences between them（P〈0.05 or P〈0.01）.However,there were no statistical significant differences in terms of bacteroides and clostridium between the two groups （P〉0.05）.Fecal SIgA levels in test group cases were higher than that of control group cases on the 8th day and the 15th day of nutritional support （P〈0.05）.The incidence of infectious complications in test group cases was lower than that of control group cases （33.33% vs 50.00%）,but there was no statistical significant difference between them（P〉0.05）.Conclusion：Compared with common enteral nutrition,enteral nutrition combined with synbiotics agents can effectively improve intestinal flora imbalance and enhance intestinal immune function for patients with severe craniocerebral injury.