CAJ | 학술논문

目的探讨肠外营养(PN)、肠内营养(EN)及肠外肠内联合营养(PN+ EN)支持对高血压脑出血患者体液免疫功能,并发症及临床预后的影响.方法筛选2010年1月至2011年5月入住神经科ICU的90例高血压脑出血术后患者,依据入院时间随机分为PN组、EN组及PN+ EN组.对每组分别给予相应的营养治疗.于营养支持治疗1d和14 d抽取外周静脉血测IgA、IgG、IgM、白蛋白及前白蛋白,对比三组患者体液免疫水平的变化.记录并对比三组患者临床并发症及预后的差异.结果临床营养治疗前三组患者体液免疫指标对比差异无统计学意义(P＞0.05),营养治疗后差异有统计学意义(P＜0.05).使用q检验比较营养治疗后的差异:EN组IgM,白蛋白和前白蛋白显著高于PN组(P＜0.05,P＜0.01);PN+ EN组IgA,IgM,IgG,白蛋白和前白蛋白显著高于PN组(P ＜0.05,P＜0.01);PN+ EN组IgA,白蛋白和前白蛋白显著高于EN组(P ＜0.05,P＜0.01).PN+ EN组与PN组相比,发现PN+EN组在减少消化道应激性溃疡方面优于PN组,差异有统计学意义(P＜0.05).PN+ EN组在减少腹泻及吸入性肺炎方面明显优于EN组,差异有统计学意义(P ＜0.01).结论高血压脑出血术后患者早期给予肠内肠外联合营养支持是提高患者免疫功能的最佳选择,也是减少各种并发症的最佳选择.
목적 탐토장외영양(PN)、장내영양(EN)급장외장내연합영양(PN+ EN)지지대고혈압뇌출혈환자체액면역공능,병발증급림상예후적영향.방법 사선2010년1월지2011년5월입주신경과ICU적90례고혈압뇌출혈술후환자,의거입원시간수궤분위PN조、EN조급PN+ EN조.대매조분별급여상응적영양치료.우영양지지치료1d화14 d추취외주정맥혈측IgA、IgG、IgM、백단백급전백단백,대비삼조환자체액면역수평적변화.기록병대비삼조환자림상병발증급예후적차이.결과 림상영양치료전삼조환자체액면역지표대비차이무통계학의의(P＞0.05),영양치료후차이유통계학의의(P＜0.05).사용q검험비교영양치료후적차이:EN조IgM,백단백화전백단백현저고우PN조(P＜0.05,P＜0.01);PN+ EN조IgA,IgM,IgG,백단백화전백단백현저고우PN조(P ＜0.05,P＜0.01);PN+ EN조IgA,백단백화전백단백현저고우EN조(P ＜0.05,P＜0.01).PN+ EN조여PN조상비,발현PN+EN조재감소소화도응격성궤양방면우우PN조,차이유통계학의의(P＜0.05).PN+ EN조재감소복사급흡입성폐염방면명현우우EN조,차이유통계학의의(P ＜0.01).결론 고혈압뇌출혈술후환자조기급여장내장외연합영양지지시제고환자면역공능적최가선택,야시감소각충병발증적최가선택.
Objective To clarify the effects of treatment with enteral combined with parenteral nutrition (PN + EN) on humor immune function and clinical conplications of patients with hypertensive intracerebral hemorrhage in neurosurgical intensive care unit.Methods In this prospective control study,90 patients with hypertensive intracerebral hemorrhage accepted therapy in the NICU (between January 2010and May 2011) were randomly divided into 3 groups: the parenteral nutrition group (PN),early enteral nutrition group (EN),and early PN + EN group.The different nutrition treatments were performed according to the corresponding groups.The plasma immunoglobulin (IgA,IgM and IgG),albumen and prealbumin were tested on the 1st day and the 14th day.The changes of humor immunological indicators of the patients before and after nutritional treatment were compared among three groups.The complications and clinical outcomes were also recorded and compared.Results The differences of plasma immunoglobulin among 3groups before nutritional treatment were confirmed to be indistinctive (P ＞ 0.05).But the differences after nutritional treatment were significance (P ＜ 0.05).The q test was used to detect the statistical significance about the data after nutritional treatment.Compared with the PN group,the levels of IgM,albumen and prealbumin were significantly higher in EN group (P ＜ 0.05,P ＜ 0.01).Compared with the PN group,the levels of IgA,IgM,IgG,albumen and prealbumin were significantly higher in PN + EN group (P ＜0.05,P ＜0.01).Compared with the EN group,the levels of IgA,albumen and prealbunin were significantly higher in PN + EN group (P ＜ 0.05,P ＜ 0.01).In PN + EN group,the rate of stress ulcer was lower than that in PN group (P ＜ 0.05),the rates of aspirated pneumonia and diarrhea were lower than those in EN group (P ＜ 0.05).Conclusions Compared with single enteral or parenteral nutrition,the carly PN + EN treatment could promote the recovery of the humor immune function in patients with hypertension cerebral hemorrhage.The early PN + EN treatment could decrease the complications of patients.