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个性化营养配方对重型颅脑损伤患者炎症指标、免疫状态及胃肠道耐受性的临床观察

Clinical observation of individualized nutritional formula on inflammation index, immune status and gastrointestinal tolerance in patients with severe head injury.

作者信息

Zhu Chunying, Zhang Yingfu, Li Wei, Li Qianqian

机构信息

Chunying Zhu, Department of Neuroscience Critical Care Unit, Baoding No.1 Central Hospital, Baoding, 071000, Hebei, China.

Yingfu Zhang, Endoscopic Diagnosis and Treatment Center, Baoding No.1 Central Hospital, Baoding, 071000, Hebei, China.

出版信息

Pak J Med Sci. 2021 Jul-Aug;37(4):952-958. doi: 10.12669/pjms.37.4.3987.

Abstract

OBJECTIVES

To evaluate the clinical significance of individualized nutritional formulas on inflammatory factors, immune status and gastrointestinal tolerance in patients with severe head injury.

METHODS

A total of 80 patients with severe head injury who were hospitalized in Baoding No.1 Central Hospital from March 2017 to March 2020 were randomly divided into two groups with 40 cases in each group. Patients in both groups were given enteral nutrition (EN), the control group was given conventional enteral nutrition formula through nasointestinal tube, and the experimental group was given individualized nutrition formula. All patients were tested for tumor necrosis factor(TNF-α), C-reactive protein(CRP), interleukin 6(IL-6), IgA, IgM, IgG, serum intestinal fatty acid binding protein(I-FABP) and D-lactic acid concentration before and after enteral nutrition treatment. The incidence of adverse reactions such as abdominal distension, diarrhea, constipation, and gastric retention within seven days after treatment of two groups were compared and analyzed.

RESULTS

There was no significant difference in inflammatory factors such as TNF-a, CRP, IL-6, immunoglobulin levels, I-FABP and D-lactic acid concentration between the two groups before treatment (p>0.05). After treatment, the above indicators of the two groups of patients were better than before treatment, the difference was statistically significant (p<0.05), and the experimental group was significantly better than the control group (p<0.05). The experimental group had a gastrointestinal adverse reaction rate of 10%, and the control group had 27.5%, the difference was statistically significant (p=0.04).

CONCLUSIONS

Individualized nutritional formula has more significant advantages than conventional nutritional formula for patients with severe head injury, which can reduce inflammatory response, increase the patient's immune level, improve the intestinal mucosal barrier function, have good gastrointestinal tolerance, and have a low incidence of adverse reactions.

摘要

目的

评估个体化营养配方对重型颅脑损伤患者炎症因子、免疫状态及胃肠道耐受性的临床意义。

方法

选取2017年3月至2020年3月在保定市第一中心医院住院的80例重型颅脑损伤患者,随机分为两组,每组40例。两组患者均给予肠内营养(EN),对照组经鼻肠管给予常规肠内营养配方,试验组给予个体化营养配方。所有患者在肠内营养治疗前后检测肿瘤坏死因子(TNF-α)、C反应蛋白(CRP)、白细胞介素6(IL-6)、IgA、IgM、IgG、血清肠脂肪酸结合蛋白(I-FABP)及D-乳酸浓度。比较并分析两组治疗后7天内腹胀、腹泻、便秘、胃潴留等不良反应的发生率。

结果

治疗前两组患者TNF-a、CRP、IL-6等炎症因子、免疫球蛋白水平、I-FABP及D-乳酸浓度比较,差异无统计学意义(p>0.05)。治疗后,两组患者上述指标均较治疗前好转,差异有统计学意义(p<0.05),且试验组明显优于对照组(p<0.05)。试验组胃肠道不良反应发生率为10%,对照组为27.5%,差异有统计学意义(p=0.04)。

结论

个体化营养配方对重型颅脑损伤患者较传统营养配方具有更显著优势,可减轻炎症反应,提高患者免疫水平,改善肠黏膜屏障功能,具有良好的胃肠道耐受性,不良反应发生率低。

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