不同比例肠内联合肠外营养治疗方案对重型颅脑创伤患者的影响

摘要 目的：探讨不同比例的肠内联合肠外营养治疗方案对重型颅脑创伤患者（sTBI）的影响。方法：选择2020年10月-2022年8月重庆市急救医疗中心神经重症监护室收治的sTBI患者为研究对象。将符合纳入和排除标准70例患者随机分为实验组和对照组各35例。计算患者每日所需热量，按不同比例的肠内联合肠外营养方案给予营养支持。实验组为按2：1比例肠内联合肠外营养支持，对照组为按1：1比例肠内联合肠外营养支持。统计比较两组的营养状态指标（血红蛋白、白蛋白、前白蛋白、总蛋白），免疫功能指标CD3、CD4、CD4/CD8、免疫球蛋白（Ig）A、IgM、IgG]，炎症指标C-反应蛋白（CRP）、降钙素原（PCT）、白介素-6（IL-6）]并发症的差异。结果：在免疫功能方面，营养支持14 d后实验组患者的CD4、CD4/CD8、IgA水平高于对照组患者，差异有统计学意义（P<0.05）；而在营养状态、炎症指标及并发症等方面两组患者差异无统计学意义（P>0.05）。结论：肠内营养为主的联合营养支持方式更能促进sTBI患者的免疫功能恢复，但不同比例肠内联合肠外营养治疗方案在营养状态、炎症指标及并发症等指标方面无明显差异。

Effect of Different Proportions of Enteral Combined with Parenteral Nutrition Treatment on Patients with Severe Traumatic Brain Injury

ABSTRACT Objective: To investigate the effect of different proportions of enteral combined with parenteral nutrition treatment on patients with severe traumatic brain injury (sTBI). Methods: The subjects of study were sTBI patients admitted to the Neurointensive Care Unit of Chongqing Emergency Medical Center from October 2020 to August 2022.70 patients who met the inclusion and exclusion criteria were randomly divided into the experimental group and the control group with 35 cases each. Calculate the daily caloric requirements of patients and provide nutritional support according to different proportion of enteral and parenteral nutrition programs. The experimental group was given enteral and parenteral nutrition support at a ratio of 2:1, while the control group was given enteral and parenteral nutrition support at a ratio of 1:1. The differences of nutritional status indicators (hemoglobin, albumin, prealbumin, total protein),immune function indicatorsCD3, CD4, CD4/CD8, immunoglobulin(Ig)A, IgM, IgG], inflammatory indicatorsC-reactive protein(CRP),procalcitonin(PCT), interleukin-6(IL-6)]and complications between the two groups were statistically compared. Results: In terms of immune function, the levels of CD4, CD4/CD8 and IgA in the experimental group were significantly higher than those in the control group 14 d after nutritional support(P<0.05); There was no significant difference between the two groups in nutritional status, inflammatory indicators and complications(P>0.05). Conclusion: Enteral nutrition-based combined nutritional support can promote the recovery of immune function in patients with sTBI, but there is no significant difference in nutritional status, inflammatory indicators and complications between different proportions of enteral combined parenteral nutrition treatment.