序贯肠内外营养支持对AECOPD合并呼吸衰竭患者营养指标、胃肠黏膜功能和免疫功能的影响

摘要 目的：观察序贯肠内外营养支持在慢性阻塞性肺疾病急性加重期（AECOPD）合并呼吸衰竭患者中的应用价值。方法：选用随机数字表法将我院2019年1月-2020年12月期间收治的90例AECOPD合并呼吸衰竭患者分为肠内组（n=30）、肠外组（n=30）和序贯组（n=30）。对比三组患者营养指标、胃肠黏膜功能和免疫功能,观察并记录三组抗菌药物使用天数、住院天数和并发症发生率。结果：序贯组的抗菌药物使用天数、住院天数短于肠内组、肠外组（P<0.05）。序贯组营养支持2周后白蛋白（ALB）、前白蛋白（PA）、转铁蛋白（TF）均高于肠内组、肠外组（P<0.05）。序贯组营养支持2周后免疫球蛋白（Ig）A、IgM、IgG均高于肠内组、肠外组（P<0.05）。序贯组营养支持2周后D-乳酸、二胺氧化酶（DAO）均低于肠内组、肠外组（P<0.05）。三组并发症发生率组间对比无明显差异（P>0.05）。结论：序贯肠内外营养支持应用于AECOPD合并呼吸衰竭患者,可促进患者免疫功能提高,营养状况改善,同时还可促进胃肠黏膜功能恢复,缩短抗菌药物使用天数和住院天数。     

Nutritional support of children in the intensive care unit.

Nutritional support is an integral and essential part of the management of 5-10 percent of hospitalized children. Children in the intensive care unit are particularly likely to develop malnutrition because of the nature and duration of their illness, and their inability to eat by mouth. This article reviews the physiology of starvation and the development of malnutrition in children. A method of estimating the nutritional requirements of children is presented. The techniques of nutritional support, including enteral, peripheral, and central parenteral nutrition are discussed in detail. Appropriate formulas are given for different age groups. Electrolyte, vitamin, and mineral supplements are discussed. Guidelines are provided for choosing between peripheral and central total parenteral nutrition. A monitoring protocol is suggested and complications of nutritional therapy are reviewed. Safe and effective nutritional support requires considerable investment of time and effort by members of the nutrition team.     

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。     

不同营养支持方式对进展期胃癌术后病人临床结局比较

摘要目的：研究肠内营养、肠外营养、常规补液对胃癌术后患者临床结局的影响。方法：择我院住院治疗并行外科手术治疗的胃 癌患者183 例,随机分至肠内营养组、肠外营养组、常规补液组,分别行相应的营养支持治疗,比较三组患者术前/ 后1 天及术后 8 天体重、白蛋白、淋巴细胞计数的变化及术后并发症发生情况、营养支持费用、术后住院时间、总费用。结果：常规补液组术后第 8 天体重较术前1 天明显下降;肠内、肠外营养组患者体重下降幅度均明显低于常规补液组;肠内、肠外营养组术后第8 天白蛋白 水平升高显著,且明显高于常规补液组;肠内营养组患者术后第8 天淋巴细胞明显上升,且较常规补液组有明显升高。肠外营养 组、常规补液组患者肝功能损害、血脂升高、血糖升高的发生率均明显高于肠内营养组;肠外营养组患者肝功能损害、血脂升高发 生率明显低于常规补液组;肠内营养组患者切口腹腔感染及肺部感染的发生率均明显低于常规补液组。与常规补液组相比,肠 外、内营养组患者术后住院时间均明显缩短,肠内营养组患者总费用明显偏高;与肠外营养相比,肠内营养组、常规补液组营养支 持费用明显降低,肠内营养组患者总费用显著下降,上述差异均有统计学意义（P＜0.05）。结论：胃癌术后患者行肠内营养可大大 降低术后并发症的发生,并减少患者住院费用,缩短术后住院时间。     

不同营养支持方式对进展期胃癌术后病人临床结局比较

目的：研究肠内营养、肠外营养、常规补液对胃癌术后患者临床结局的影响。方法：择我院住院治疗并行外科手术治疗的胃癌患者183例,随机分至肠内营养组、肠外营养组、常规补液组,分别行相应的营养支持治疗,比较三组患者术前／后1天及术后8天体重、白蛋白、淋巴细胞计数的变化及术后并发症发生情况、营养支持费用、术后住院时间、总费用。结果：常规补液组术后第8天体重较术前1天明显下降;肠内、肠外营养组患者体重下降幅度均明显低于常规补液组;肠内、肠外营养组术后第8天白蛋白水平升高显著,且明显高于常规补液组;肠内营养组患者术后第8天淋巴细胞明显上升,且较常规补液组有明显升高。肠外营养组、常规补液组患者肝功能损害、血脂升高、血糖升高的发生率均明显高于肠内营养组;肠外营养组患者肝功能损害、血脂升高发生率明显低于常规补液组;肠内营养组患者切口腹腔感染及肺部感染的发生率均明显低于常规补液组。与常规补液组相比,肠外、内营养组患者术后住院时间均明显缩短,肠内营养组患者总费用明显偏高;与肠外营养相比,肠内营养组、常规补液组营养支持费用明显降低,肠内营养组患者总费用显著下降,上述差异均有统计学意义（P〈O．05）。结论：胃癌术后患者行肠内营养可大大降低术后并发症的发生,并减少患者住院费用,缩短术后住院时间。     

Oral contraceptive use and venous thromboembolism: absence of an effect of smoking.

We conducted a case-control study to test the hypothesis that women smokers who use oral contraceptives have an increased risk of developing venous thrombosis. Patients and controls were drawn from two sets of hospital patients already included in the Boston Collaborative Drug Surveillance Programme. Sixty patients with uncomplicated thromboembolism were matched with 180 controls with other diagnoses; all were premenopausal women taking oral contraceptives. Patients with conditions that might predispose to thromboembolism or be related to smoking were excluded. We found no association between smoking habits and thromboembolism. Similarly, we found no association between thromboembolism, smoking, and duration of oral contraceptive use. Thus we conclude that differences in fibrinolytic activity between smokers and non-smokers are not major factors in the aetiology of uncomplicated thromboembolism in women using oral contraceptives.     

营养风险筛查及肠内营养支持对老年患者营养状况和感染性并发症的影响

目的：观察营养支持治疗在老年住院患者整体治疗中的重要性。方法：采用营养风险筛查方法NRS2002,对2009年7月-2012年3月在我院内科干部病房住院的老年患者进行营养风险筛查,选取NRS2002评分〉13分的有营养风险患者62例,随机分为2组,应用肠内营养持支持组和普通饮食对照组,各31例。分析营养支持治疗对患者实验室营养指标：包括血清白蛋白（ALB）、前白蛋白（PA）、总胆固醇（TC）、血红蛋白（Hb）水平影响及感染性并发症：包括肺部感染、尿路感染、褥疮发生率的影响变化。结果：入院14d后,营养支持组各营养指标均显著高于对照组值,差异有统计学意义（P〈0．05）;营养支持组肺部感染、褥疮、尿路感染的发生率均显著低于对照组（P〈0．05）。结论：肠内营养可以使有营养风险的老年住院患者的营养状况得到改善,同时减轻显著降低其肺部感染、褥疮、尿路感染并发症的发生率,改善老年患者的生活质量。     

Selenium depletion in patients on home parenteral nutrition

Severe selenium (Se) depletion was found in nine patients receiving long-term home parenteral nutrition because of short bowel syndrome. Plasma Se ranged from 0–0.51 (median 0.21 μmol/L) and erythrocyte Se ranged from 0.7–2.6 (median 1.8 μmol/gHgb), which was significantly lower than in the controls. Glutathione peroxidase (GSHPx) in plasma and erythrocytes was also decreased. After bolus injections with 200 μg Se/d in the form of sodium selenite for 4 mo, followed by 100 μg/d for 8 mo, plasma Se increased to values slightly but significantly higher than in the controls. Erythrocyte Se reached normal levels in most of the patients after 4 mo substitution, but it remained lower than in the controls. Following Se supplementation, plasma and erythrocyte GSHPx did not differ between patients and controls. These data suggest that all patients receiving long-term parenteral nutrition because of short bowel syndrome should receive at least 100 μg sodium selenite/d when given as bolus injections to avoid Se depletion.     

肺功能康复训练联合肠外氨基酸营养支持对非小细胞肺癌化疗患者营养状态、癌因性疲乏及生活质量的影响

摘要 目的：探讨肺功能康复训练联合肠外氨基酸营养支持对非小细胞肺癌（NSCLC）化疗患者营养状态、癌因性疲乏及生活质量的影响。方法：选取2016年6月~2019年10月期间本院收治的NSCLC化疗患者137例。根据随机数字表法将患者分为对照组（68例,给予常规干预）、观察组（69例,在对照组基础上给予肠外氨基酸营养支持联合肺功能康复训练）,对比两组干预前后的营养状态、肺功能、癌因性疲乏及生活质量。结果：与对照组相比,观察组干预后白蛋白、总蛋白、血红蛋白更高（P<0.05）。干预后观察组用力肺活量（FVC）、第1s用力呼气容积占预计值百分比（FEV₁%）、呼气峰流速值（PEF）高于对照组（P<0.05）。观察组干预后Piper 疲乏量表（PFS）的行为疲乏、情感疲乏、躯体疲乏、认知疲乏评分低于对照组（P<0.05）。观察组干预后生活质量评估量表（EORTC QLQ-C30）各维度评分较对照组更高（P<0.05）。结论：肺功能康复训练联合肠外氨基酸营养支持干预NSCLC化疗患者,可改善患者的营养状态及肺功能,缓解患者癌因性疲乏程度,改善其生活质量。     

Effect of structured lipid-enriched total parenteral nutrition in rats bearing yoshida sarcoma

The efficacy of structured lipid, a triacylglycerol of medium and long chain fatty acids, as an element of nutritional support therapies in cancer cachexia was investigated. Using the Yoshida sarcoma to induce cachexia, male Sprague Dawley rats (90 g) were injected subcutaneously with tumor cells (n = 17) or sterile saline (n = 16). Seven days later, rats were randomized to two intravenous diets for 3 days at 220 kcal/kg body weight/d, including 2 g nitrogen/kg body weight/d and 39% of total calories as either structured lipid or long chain triglyceride. Nitrogen balance, tumor growth rate, energy metabolism, and plasma albumin and free fatty acid levels were measured, and whole-body protein kinetics and liver, muscle, and tumor fractional protein synthetic rates were evaluated by adding (14)C-leucine to the diet during the last 4 hours of feeding. Nitrogen balance improved (P < .05) in both tumor and control rats receiving structured lipid-enriched total parenteral nutrition, and was also greater in tumor rats compared with controls. There were no differences in tumor growth or protein kinetics between diet groups. Albumin was lower (P < .05) in tumor rats, but significantly higher in both tumor and control rats given structured lipid-enriched total parenteral nutrition. Free fatty acid was significantly higher in tumor rats versus controls. Whole-body protein kinetics were similar among the four groups. Liver weight, liver weight to body weight ratio, and liver protein synthetic rate were higher in tumor rats. Also, liver weight to body weight ratio was lower in tumor and control animals given structured lipid-enriched total parenteral nutrition. Muscle protein synthetic rate was significantly lower in tumor rats, but higher in tumor and control rats given long chain triglyceride-enriched total parenteral nutrition. The nutritional benefits of structured lipid-enriched total parenteral nutrition favor support of host tissue without promoting tumor growth.     

添加丙氨酰谷氨酰胺的胃肠外营养对存在营养风险的胃癌根治术患者免 疫功能、营养状态及术后恢复的临床意义*

目的:本研究旨在探讨NRS评分大于5分的胃癌根治术患者围手术期应用丙氨酰谷氨酰胺(Ala-Gln)强化的肠外营养对免疫功能、营养状况及术后恢复情况的临价值。方法:NRS-2002评分大于5分的胃癌患者60例,随机分为两组,每组30例。术前开始给予肠外营养支持,5日后手术,手术方式为根治性胃切除,包括远端胃大部切除术和全胃切除术。术后继续给予常规肠外营养。只有实验组给予谷氨酰胺双肽每日20克。于入院时和手术后第6日测量CD4、CD8、CD4/CD8、IgG、IgA、IgM淋巴细胞计数等免疫指标,血清总蛋白、白蛋白、谷丙转氨酶、总胆红素、血肌酐等肝肾功能指标,观察手术恢复过程及术后并发症发生情况。结果:采用谷氨酰胺强化的试验组CD4、CD8等免疫指标恢复情况显著优于对照组。二者一过性肝功能损伤发生率无明显差异。但试验组白蛋白较对照组恢复迅速。试验组术后肠蠕动恢复较对照组快,术后腹泻发生率较低。两组在术后抗生素应用时间、术后感染等发病率方面未显示统计学差异。结论:对存在营养风险的胃癌患者进行围手术期静脉营养支持时添加谷氨酰胺制剂可明显改善患者的免疫状况,促进术后恢复减少手术并发症。     

Nutrición basada en la evidencia en la pancreatitis aguda y la enfermedad hepática crónica estable

Acute pancreatitis is a disease that, by definition, generates an increase in metabolism. This metabolic reaction, together with the anorexia produced by the disease, clearly increases morbidity and mortality secondary to malnutrition.Malnutrition affects almost 70% of patients with cirrhosis, with a consequent increase in complications. The present review aims to evaluate the utility of the use of total parenteral nutrition (TPN) and/or enteral nutrition (EN) in patients with acute pancreatitis and in those with stable chronic liver disease.In patients with acute pancreatitis, the administration of enteral nutrition seems to confer advantages over parenteral nutrition in clinical variables (infections, surgical interventions, and mean length of hospital stay) (A-B); nevertheless, further studies stratifying patients according to the severity of pancreatitis and probably its etiology should be designed. Glutamine supplementation can be effective in reducing length of hospital stay and duration of nutritional support (B).In patients with stable chronic liver disease, there are no studies that demonstrate the superiority of EN over PN, or vice versa, in relevant clinical variables (mortality, length of hospital stay, etc.). There is only one study that has demonstrated that EN is superior to oral intake in reducing mortality (B).Improved study designs and the need to perform studies according to the type and severity of liver disease should be a research priority.     

Stimulation of cholesterol synthesis and hepatic lipogenesis in patients with severe malabsorption

Patients with severe malabsorption have abnormal lipid metabolism with low plasma cholesterol and frequently high triglyceride (TG) levels. The mechanisms behind these abnormalities and the respective roles of malabsorption itself and of the parenteral nutrition given to these patients are unclear. We measured endogenous lipids synthesis (cholesterol synthesis and hepatic lipogenesis) and the expression (mRNA concentrations in circulating mononuclear cells) of regulatory genes of cholesterol metabolism in 10 control subjects and 22 patients with severe malabsorption receiving (n = 18) or weaned of parenteral nutrition (n = 4). Patients had low plasma cholesterol (P < 0.01) and raised TG (P < 0.05) levels. Both fractional and absolute cholesterol synthesis (P < 0.001) and hepatic lipogenesis (P < 0.01) were increased. These abnormalities are independent of parenteral nutrition since they were present in patients receiving or weaned of parenteral nutrition. No relation between hepatic lipogenesis and plasma TG levels was found, suggesting that other metabolic abnormalities participated in hypertriglyceridemia. HMG-CoA reductase and LDL receptor mRNA levels were decreased (P < 0.05) in patients on long-term parenteral nutrition. HMG-CoA reductase mRNAs were normal in weaned patients.Severe malabsorption induces large increases of cholesterol synthesis and hepatic lipogenesis independently of the presence of parenteral nutrition. These abnormalities are probably due to the malabsorption of bile acids.     

老年吻合器痔上黏膜环切钉合术后肠内营养制剂的应用效果观察

目的:探讨口服肠内营养制剂对老年吻合器痔上黏膜环切钉合术(PPH)术后患者营养状况及排便的影响。方法:选择2013年1月-2015年1月在我院行PPH治疗的老年患者120例,依据随机数字表法将患者分为对照组(n=60)和观察组(n=60),术后对照组通过静脉补液的方式给予常规肠外营养,观察组口服肠内营养剂安素,两组营养支持均维持3-5天。比较两组患者术前和术后3d血白蛋白(ALB)、前白蛋白(PA)、淋巴细胞计数(LYC)、血红蛋白(Hb)的差异,记录两组患者术后首次排便时间和3d内的排便次数。结果:术后第3d,观察组PA和LYC显著高于对照组,差异有统计学意义(P0.05);两组术后排便次数和首次排便时间差异均无统计学意义(P0.05)。结论:口服肠内营养制剂作为老年PPH术后患者的营养支持方式,能满足老年患者的营养需求,改善免疫功能,并且不刺激排便,值得临床推广使用。     

胃癌术后早期肠内营养支持的临床观察

目的:观察胃癌术后早期肠内营养支持的临床效果。方法:将76例患者随机分成早期肠内营养(EEN)组和未施行肠内营养(N-EEN)组(n=38),EEN组于胃癌术后24h经术中放置的鼻空肠管应用能全力进行早期肠内营养,N-EEN为术后静脉营养,术前、术后7天测定血清白蛋白、前白蛋白和体重、记录术后肠蠕动、排气时间和术后并发症。结果:两组肠鸣音恢复时间差异无统计学意义,EEN组术后肛门排气时间明显早于N-EEN组(P<0.05);两组术后体重均低于术前,但N-EEN组体重下降更明显,差异有统计学意义(P<0.05);术后第7天,两组患者血清白蛋白、前白蛋白均较术前下降,差异有统计学意义(P<0.05),但两组白蛋白下降的差异无统计学意义,而N-EEN组前清蛋白下降明显,差异有统计学意义(P<0.05)。结论:胃癌术后EEN安全、可靠,具有维护机体代谢平衡、促进肠蠕动的作用,并可减少术后并发症。     

胃癌术后早期经鼻空肠营养管肠内营养患者的强化护理的临床效应

目的:探讨强化护理措施对胃癌患者术后营养状态的改善作用,为减少术后营养相关并发症的发生提供可借鉴的方法。方法:选择2012年1月-2013年12月在我科实施胃癌手术患者的临床资料进行分析,根据术后营养支持方式的不同,将患者分为早期肠内营养支持组和常规肠内营养组。观察并比较两组患者的生命体征变化、术后肛门排气时间及并发症的发生情况等。结果:强化护理组23例胃癌患者给予术后早期肠内营养治疗后,恢复肛门排气时间为53±7.4 h,经过5±2.1 d的肠内营养后,术后体重增加1.2±0.4 kg,无肠内营养相关并发症发生,肠外营养支持时间明显缩短。结论:本研究显示强化早期肠内营养护理具有迅速改善胃癌病人营养不良状态,减少营养不良相关并发症发生,减轻病人经济负担等优点。     

Malnutrition and the heart.

Earlier concepts that the heart is spared in malnutrition have been shown to be incorrect. Inadequate intake of protein and energy results in proportional loss of skeletal and myocardial muscle. As myocardial mass decreases, so does the ability to generate cardiac output; however, various compensatory factors come into play. Nutritional supplementation for malnourished patients reverses the compensatory factors and may increase the short-term potential for heart failure. Severe cardiac debility results in poor nutrition, which may in turn produce unsuspected but clinically significant myocardial atrophy. Nutritional support may play a role in improving cardiac function in selected patients with cardiac cachexia who are being prepared for cardiac surgery and in patients with rapid weight loss who are at risk for sudden death due to arrhythmias. Malnutrition is common in hospitalized patients, and many patients in hospital now receive nutritional supplementation; both facts have important cardiac implications.     

General practitioner response to elderly patients discharged from hospital.

OBJECTIVE--To determine the effect of discharge information given to general practitioners on their management of newly discharged elderly patients. DESIGN--A random sample of 133 elderly patients who had unplanned readmission to a district general hospital within 28 days of discharge was compared with a matched control sample of patients who were not readmitted. Information was gathered from the hospital, the patients, the carers, and the general practitioners about the information that the hospital had sent the general practitioner and the general practitioners'' response to this information. SETTING--All specialties in a district general hospital. PATIENTS--266 Patients aged over 65 representative in the main demographic indices of the population of elderly patients admitted to hospital. RESULTS--Ten weeks after discharge the doctors had received notice of discharge about 169 of the patients, but fewer than half the discharge notices were received within the first week. General practitioners were dissatisfied with the information in 60 cases. A general practitioner visited 174 of the patients after their discharge from hospital and three quarters of the visits took place within two weeks of the discharge. These visits were more likely to have been initiated by patients or families than by the doctor, and this was not influenced by the doctor receiving notice of the patient''s discharge. Older patients and those who had carers were the most likely to be visited. Nearly half of the carers were dissatisfied with some aspect of general practitioner care, problems with home visiting being the commonest source of complaint. CONCLUSIONS--Hospital communications to general practitioners about the discharge of elderly patients still cause concern, particularly in the time they take to arrive. Written instruction to vulnerable elderly patients asking them to inform their general practitioner of the discharge might be helpful. Carers complained of lack of support, and it is clearly important for someone (either the general practitioner or another health worker) to visit elderly people shortly after their discharge.     

The Management of Hyperglycemia in Noncritically ill Hospitalized Patients Treated with Continuous Enteral or Parenteral Nutrition

Objective: Hyperglycemia is a common problem in hospitalized patients receiving artificial nutrition, and this development of hyperglycemia during parenteral nutrition therapy (PNT) and enteral nutrition therapy (ENT) increases the risks of hospital-related complications and mortality. This review aims to discuss the pathogenesis of hyperglycemia from artificial nutrition in the hospital, summarize current evidence on the treatment of hyperglycemia with insulin in these patients, and review current guidelines.Methods: A systematic literature review using PubMed and the Medical Subject Headings (MeSH) terms “hyperglycemia,” “enteral nutrition,” and “parenteral nutrition” were used to evaluate the current evidence available for treating noncritically ill patients with hyperglycemia who were receiving artificial nutrition.Results: The literature review showed that few randomized control trials exist regarding treatment of hyperglycemia in this cohort of patients, and the multiple retrospective evaluations that have addressed this topic provided varied results. In general, intravenous (IV) continuous insulin infusion offers the best glycemic control; however, this route of insulin administration is often burdensome for floor patients and their care teams. Administration of scheduled subcutaneous (SQ) insulin in patients on ENT or PNT is a safe and effective way to manage hyperglycemia, however limited data exist on an appropriate insulin regimen.Conclusion: Further prospective, randomized control trials are necessary to determine the optimal treatment of hyperglycemia for patients receiving ENT or PNT.Abbreviations: BG = blood glucose; CG = conventional glycemic control; ENT = enteral nutrition therapy; GIP = glucose-dependent insulinotropic polypeptide; GLP-1 = glucagon-like peptide 1; IG = intensive glycemic control; IV = intravenous; NPH = neutral protamine Hagedorn; PNT = parenteral nutrition therapy; SQ = subcutaneous; T2DM = type 2 diabetes mellitus; TDD = total daily dose; TPN = total parenteral nutrition     

序贯肠内营养对老年重症脑卒中患者营养代谢、免疫功能及预后的影响

目的:探讨序贯肠内营养对老年重症脑卒中患者营养代谢、免疫功能和预后的影响。方法:将90例老年重症脑卒中患者随机分为序贯肠内营养组30例、肠内营养组30例和对照组30例予以营养支持。入院第1天和第14天分别检测患者营养指标、免疫功能指标、格拉斯哥昏迷评分(GCS)、美国国立卫生院神经功能缺损评分(NIHSS);统计3组患者住院期间并发症发生率。结果:治疗14天后3组各项指标均较第1天明显下降,对照组较序贯肠内营养组和肠内营养组下降更明显;与对照组相比较,治疗14天后序贯肠内营养组和肠内营养组TLC、IgA,IgM,IgG水平明显升高;GCS评分明显升高,NIHSS评分明显降低;序贯肠内营养组、肠内营养组各项并发症较对照组发生率低。结论:老年重症脑卒中患者随病程延长,营养状况呈恶化趋势。肠内营养可改善患者营养状况,改善机体免疫功能,降低并发症发生率,改善预后。序贯肠内营养较肠内营养效果更佳。