肠内营养启动时间对重型脑外伤患者误吸率和免疫功能的影响

doi:10.3969/j.issn.1006-9771.2022.04.013

摘要/Abstract

摘要：

目的探讨重型脑外伤患者不同时间开始肠胃营养支持对创伤后早期误吸事件和免疫功能的影响。方法选取2018年6月至2021年2月在连云港市第二人民医院神经外科住院的急性脑外伤患者75例,随机分为早期喂养(24~48 h)组(n=35)和延迟喂养(48~120 h)组(n=40),比较两组14 d内反流率、误吸率、吸入性肺炎发生率、免疫指标、并发症等。结果两组反流率、误吸率和吸入性肺炎发生率比较均无显著性差异(P > 0.05)。早期喂养组IgG、IgA、补体C₃和C₄水平显著高于延迟喂养组(|t| > 1.720, P<0.001)。早期喂养组非吸入性肺部感染发生率低于延迟喂养组(χ²=4.728, P<0.05)。结论伤后24~48 h启动早期喂养可能会保护重型脑外伤患者的免疫功能,减少非吸入性肺部感染的发生。

关键词: 重型脑外伤, 早期肠内喂养, 误吸, 免疫功能

Abstract:

Objective To investigate the effect of enteral nutritional support beginning at different time on aspiration events and immune function in the early post-traumatic (within 14 days) period in patients with severe traumatic brain injury.Methods From June, 2018, to February, 2021, 75 patients with acute traumatic brain injury admitted in the Department of Neurosurgery of the Second People's Hospital of Lianyungang were randomly divided into early feeding group (24 to 48 hours, n=35) and delayed feeding group (48 to 120 hours, n=40). The 14-day reflux rate, aspiration rate, incidence of aspiration pneumonia, immune indexes and complications were compared between two groups.Results There was no significant difference in the reflux rate, aspiration rate and the incidence of aspiration pneumonia between the two groups (P > 0.05). The levels of IgG, IgA, and complements C₃ and C₄ were significantly higher in the early feeding group than in the delayed feeding group (|t| > 1.720, P<0.001). The incidence of non-aspiratory lung infections was significantly lower in the early feeding group than in the delayed feeding group (χ²=4.728, P<0.05).Conclusion Initiating enteral nutrition within 24 to 48 hours after injury may preserve immune function and reduce the incidence of non-aspiratory lung infections in patients with severe traumatic brain injury.

Key words: severe traumatic brain injury, early enteral feeding, aspiration, immune function

陈岩,王永祥,顾宜娟,刘小芹,庄倩倩,孟晓利,申潇竹. 肠内营养启动时间对重型脑外伤患者误吸率和免疫功能的影响[J]. 《中国康复理论与实践》, 2022, 28(4): 461-466.

CHEN Yan,WANG Yongxiang,GU Yijuan,LIU Xiaoqin,ZHUANG Qianqian,MENG Xiaoli,SHEN Xiaozhu. Effects of enteral nutrition beginning at different time on aspiration rate and immune function in patients with severe traumatic brain injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(4): 461-466.

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项目	早期喂养组(n=35)	延迟喂养组(n=40)	t/χ²值	P值
进食起始时间/h	39±7.08	93±12.35	3.439	< 0.001
年龄/岁	33.6±9.25	36.8±8.01	2.665	0.448
性别(男/女)/n	29/6	32/8	0.100	0.494
体质量/kg	77.63±8.13	76.33±9.04	-1.956	0.320
身高/cm	170.97±16.27	173.57±8.51	1.098	0.636
BMI/(kg ?m^-2)	25.89±5.78	24.86±7.63	-1.221	0.757
收缩压/mmHg	131±20.18	134±17.05	0.345	0.721
舒张压/mmHg	74±10.12	73±8.07	-2.241	0.382
APACHE Ⅱ评分	16.30±7.35	15.09±5.12	-1.935	0.486
GCS评分	5.14±1.24	5.09±1.12	-2.054	0.331
脑外伤原因(交通事故/高空坠落/其他)/n	15/7/13	21/9/10	1.314	0.518

组别	n	反流 (是/否)	误吸 (是/否)	吸入性肺炎(是/否)
早期喂养组	35	21/14	8/27	4/31
延迟喂养组	40	25/15	10/30	6/34
χ²值		0.049	0.047	0.013
P值		0.824	0.828	0.910

组别	n	IgG		IgA		IgM		C₃		C₄
组别	n	治疗前	14 d后	治疗前	14 d后	治疗前	14 d后	治疗前	14 d后	治疗前	14 d后
早期喂养组	35	11.57±3.61	10.79±3.78	3.02±1.03	2.76±1.12	0.95±0.36	0.75±0.42	1.23±0.51	1.06±0.38	0.15±0.08	0.10±0.04
延迟喂养组	40	12.06±3.17	7.34±2.96	2.95±0.91	1.83±1.31	1.05±0.54	0.89±0.344	1.13±0.41	0.74±0.45	0.13±0.06	0.07±0.03
t值		0.541	-1.720	-2.121	-6.623	2.857	5.324	-0.607	-3.087	-5.949	-2.026
P值		0.459	< 0.001	1.254	< 0.001	0.487	0.172	0.361	< 0.001	0.307	< 0.001

组别	n	腹泻(是/否)	便秘(是/否)	呕吐(是/否)	非吸入性肺部感染(是/否)	中枢系统感染(是/否)	泌尿系统感染(是/否)
早期喂养组	35	5/30	10/25	2/33	4/31	1/34	6/29
延迟喂养组	40	8/32	15/25	4/36	13/27	1/39	9/31
χ²值		0.425	0.670	0.066	4.728	0.000	0.335
P值		0.514	0.413	0.798	0.030	1.000	0.563