早期肠外及肠内营养续贯性治疗对神经外科ICU患者免疫功能的影响_医学论文.docVIP

早期肠外及肠内营养续贯性治疗对神经外科ICU患者免疫功能的影响_医学论文 早期肠外及肠内营养续贯性治疗对神经外科ICU患者免疫功能的影响_医学论文 作者：鲍刚，廉海平，郭世文，李涛 【摘要】 　　目的：研究早期进行全胃肠外营养（TPN）及胃肠内营养（EN）续贯性治疗对于神经外科危重患者免疫功能的影响. 方法：采用前瞻性对比研究方法，将病例随机分为早期TPN+EN续贯性治疗组和早期TPN组两组，比较营养支持后淋巴细胞中CD3+，CD4+，CD8+ 比率，CD4+/CD8+比值和血浆中IgA，IgM，IgG浓度. 结果：随着治疗时间的延长，早期TPN+EN续贯性治疗组CD3+由（51.5±6.7）%升至（61.4±6.5）％；CD4+ 由（28.5±6.4）％升至（35.9±7.2）％；CD8+ 由（19.6±6.8）％升至（21.5±6.5）％；CD4+/CD8+由（1.5±0.5）％升至（1.7±0.5）％. 血浆中IgA由（1.91±0.42） g/L升至（2.37±0.31） g/L；IgM由（1.43±0.44） g/L升至（1.85±0.41）g/L；IgG由（11.16±1.89） g/L升至(13.38±2.08) g/L. 而上述指标在早期TPN组中升高程度较小，两组间差异有统计学意义（0.05）. 结论：早期肠外及肠内营养续贯性治疗可明显促进患者免疫功能的恢复. 【关键词】 神经外科；胃肠外营养；肠内营养；免疫 　　【Abstract】 AIM: To study the effect of unremitting treatment with early enteral and parenteral nutrition on immune function of critically ill patients in neurosurgerical department. METHODS: A prospective control study was carried out. The patients were randomly divided into 2 groups: early parenteral nutrition group and unremitting treatment group with enteral and parenteral nutrition. The percentage of T lymphocyte subsets (CD3+, CD4+, CD8+), the ratio of CD4+/CD8+ and plasma levels of IgA, IgM and IgG were compared before and after treatment. RESULTS: In unremitting treatment group with enteral and parenteral nutrition, the percentage of T lymphocyte subsets CD3+ increased from （51.5±6.7）％ to (61.4±6.5)％, CD4+ from （28.5±6.4）％ to （35.9±7.2）％, CD8+ from （19.6±6.8）％ to （21.5±6.5）%, the ratio of CD4+/CD8+ from （1.5±0.5）％ to （1.7±0.5）％； and plasma levels of IgA raised from (1.91±0.42) g/L to (2.37±0.31) g/L, IgM from (1.43±0.44) g/L to (1.85±0.41) g/L, and IgG from (11.16±1.89) g/L to (13.38±2.08) g/L. The indices were significantly different with that in early parenteral nutrition group (0.05). CONCLUSION: Unremitting treatment with early enteral and parenteral nutrition can promote recovery of patients’ immune function. 　　【Keywords】 neurosurgery；parenteral nutrition；enteral nutrition；immune 　　0 引言 　　许多神经外科危重患者因为意识障碍等诸多原因而无法正常饮食，机体处于高代谢状态，出现负氮平衡、