免疫营养对脑出血患者免疫功能及预后影响的研究

摘要

Objective:Clinical study on the effects of glutamine in intracerebral hemorrhage patients on nutritional indicators and prognosis.Methods:Intracerebral hemorrhage patients were randomly divided into general nutrition group and immune nutrition group by random digits table.Both groups were treated with routine enteral nutrition(daily energy supply was calculated by a formula,the same amount off energy and nitrogen),the immune nutrition group was added glutamine[0.5g/(kg·d)].Collected the fasting blood sample before nutrition support and the seventh,fourteenth day early in the morning,then measured indicators including total serum protein(TP),albumin(ALB),prealbumin(PA),T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+),judged the GCS score of intracerebral hemorrhage patients.Results:On nutrition support for 14 days,compared the immune nutrition group,the nutritional status of general nutrition group were more worsen (P<0.05);deltoid skinfold of two groups were no statistical difference significance(P>0.05);on nutrition support for 7 and 14 days,the change of lymphocyte count in immune nutrition group were more obvious than general nutrition group (P<0.05).On nutrition support for 14 days,compared to general nutrition group,the GCS score of immune nutrition group were higher than general nutrition group(P<0.05).Conclusion:Glutamine added immune nutrition can improved the nutritional status and immunity ability of intracerebral hemorrhage patients;promoted consciousness of patients to turn for the better,in order to improve the prognosis of intracerebral hemorrhage patients.%目的:探讨免疫营养素谷氨酰胺对脑出血患者免疫功能及预后的影响.方法:将脑出血患者按随机数字表法随机分为普通营养组和免疫营养组,两组患者均采用常规肠内营养(由公式计算全天能量,保证等氮等热量营养),免疫营养组在常规营养基础上添加谷氨酰胺[0.5g/(kg·d)],其他实施常规治疗、护理.在营养支持前及营养支持第7天和第14天三个时间点采集空腹静脉血,分别测定总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)等营养指标、T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)等免疫指标,并评估患者GCS评分变化情况.结果:营养支持第14天,免疫营养组的TP、ALB、PA营养指标高于普通营养组,差异有统计学意义(P<0.05),两组患者的三角肌皮褶厚度差异无统计学意义(P>0.05);营养支持第7、14天,免疫营养组CD3+、CD4+、CD8+、CD4+/CD8+高于普通营养组,差异有统计学意义(P<0.05);营养支持第14天,免疫营养组的GCS评分高于普通营养组,差异有统计学意义(P<0.05).结论:添加谷氨酰胺的免疫营养,不但可以改善脑出血患者的营养状况,还可以提高脑出血患者的免疫能力,并促进患者意识好转,以改善脑出血患者的预后.