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

Abstract

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

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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References 28

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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

Effects of enteral nutrition beginning at different time on aspiration rate and immune function in patients with severe traumatic brain injury

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