摘要
目的探讨早期免疫营养对重型颅脑损伤(SHI)患者营养状况及免疫状态的影响。方法纳入2006年9月至2010年8月,本院重症监护病房SHI患者45例,随机分为对照组、早期营养组和早期免疫营养组,各15例。早期营养组采用肠外肠内序贯营养支持治疗。早期免疫营养组除采用肠外肠内序贯营养支持治疗外,同时给予谷氨酰胺颗粒10g,3次/d。对照组按传统方法进行营养支持。观察治疗第1、7和14d,患者血T淋巴细胞亚群、免疫球蛋白、总蛋白、白蛋白及转铁蛋白水平。结果①T淋巴细胞亚群指标:与营养治疗第1d比较,对照组第7和14d,CD3+水平较低(P<0.05),CD4+水平较低(P<0.01);与营养治疗第1d比较,早期营养组和早期免疫营养组第7d,CD4+水平较低(P<0.05);与同期对照组比较,早期营养组第14d,CD4+水平、CD4+/CD8+比值较高(P<0.05);与同期对照组比较,早期免疫营养组第7d,CD3+、CD4+水平、CD4+/CD8+比值较高(P<0.05),第14d,CD3+水平、CD4+/CD8+比值较高(P<0.05),CD4+水平较高(P<0.01)。②免疫球蛋白指标:与营养治疗第1d比较,对照组第7和14d,免疫球蛋白G(IgG)水平较低(P<0.05);与同期对照组比较,早期营养组和早期免疫营养组第14d,IgG水平较高(P<0.05)。③营养代谢指标:与营养治疗第1d比较,对照组第7d,总蛋白、白蛋白、转铁蛋白水平较低(P<0.05);与同期对照组比较,早期免疫营养组第7d,白蛋白水平较高(P<0.05)。结论 SHI患者急性期存在蛋白质代谢紊乱和免疫功能抑制。在加强治疗的同时,给予早期营养或者早期免疫营养,尤其是早期免疫营养,能促进SHI患者营养状况及免疫功能的恢复。
Objective To study the effects of early immune nutrition on nutritional status and immune state in critical patients with severe head injury （SHI）.Methods From September 2006 to August 2010,45 SHI patients in intensive care unit （ICU） were enrolled and randomly divided into control group,early nutrition group and early immune nutrition group,15 patients in each.In the early nutrition group,parenteral nutrition in turn changing into enteral nutrition was used.The early immune nutrition group was given glutamine granules additionally（10 g,three times per day）.While in the control group,the traditional nutrition support method was performed.The levels of T lymphocyte subgroup,immunoglobulin,total protein,albumin,and transferrin after therapy （1,7,14 d） were detected in all the three groups.Results Compared with the first day of nutrition support,the levels of CD3＋ and CD4＋ were lower in the control group （P0.05,P0.01 respectively） on the 7th and 14th d,and the levels of CD4＋ were lower in both the early nutrition group and the early immune mutrition group on the 7th d （P0.05）.Compared with the concurrent control group,the level of CD4＋ and the CD4＋/CD8＋ ratio were higher in the early nutrition group on the 14th d （P0.05）,and the levels of CD3＋,CD4＋ and the CD4＋/CD8＋ ratio were higher in the early immune nutrition group on the 7th d （P0.05）.Meanwhile,on the 14th d,the level of CD3＋,CD4＋,and the CD4＋/CD8＋ ratio were higher in the early immune nutrition group.Compared with the first day of nutrition support,the levels of immunoglobulin G （IgG） were lower in the control group on the 7th and 14th d （P0.05）.However,compared with the concurrent control group,the levels of IgG were higher in both the early nutrition group and the early immune nutrition group on the 14th d （P0.05）.Compared with the first day of nutrition support,the levels of total protein,albumin,and transferrin were lower in the control group on the 7th d （P0.05）.At the same time,the level of albumin was higher in early immune nutrition group,compared with the concurrent control group （P0.05）.Conclusions Protein metabolic disorder and immune function inhibition occurred in SHI patients on acute stage.Besides strengthening therapy,given early nutrition or early immune nutrition may accelerate the recoveries of nutritional status and immune state in SHI patients.
出处
《中华危重症医学杂志（电子版）》
CAS
2010年第4期10-14,共5页
Chinese Journal of Critical Care Medicine:Electronic Edition
基金
浙江省温州市科技局资助项目(Y20070105)
