【摘要】 目的探讨复方嗜酸乳杆菌片联合早期肠内营养在重型颅脑损伤患者中的应用。方法选取ICU住院治疗的重度颅脑损伤患者84例,采用随机数字表分为观察组和对照组,每组42例。两组患者均予以控制颅内压、抗生素预防感染、保护胃黏膜和营养脑细胞等常规治疗,并予以肠内营养混悬液以100m L/h的滴速持续滴注2 000~2 500 m L/d。观察组患者加用复方嗜酸乳杆菌片0.5g,药物研磨后用20m L温水溶解后胃管注入,3次/d,连用10 d。观察并记录两组患者治疗前和治疗10 d后GCS评分、SOFA评分及APACHE II评分,血清白蛋白(ALB)、血红蛋白(Hb)和肠道sIgA水平的变化。结果治疗10d后,两组患者GCS评分均有不同程度上升,SOFA评分及APACHE Ⅱ评分均有不同程度下降(P<0.05或P<0.01),且观察组上升或下降值明显高于对照组(P<0.05);两组患者血清白蛋白(ALB)、血红蛋白(Hb)水平均有不同程度下降(P<0.05或P<0.01),且观察组下降值明显低于对照组(P<0.05);同时观察组患者肠道s Ig A水平较前明显上升(P<0.05),而对照组治疗前后sIgA水平无明显变化(P<0.05)。结论复方嗜酸乳杆菌片联合早期肠内营养治疗重型颅脑损伤疗效确切,能提高GCS评分和降低SOFA评分及APACHEⅡ评分,减缓血清ALB、Hb水平下降幅度,改善其营养状况;并能提高肠道slgA水平,增强其肠道黏膜局部免疫力。更多还原

【Abstract】 Objective To discuss the application of Compound Lactobacillus Acidophilus Tablets combined with early enteral nutrition in patients with severe craniocerebral injury. Methods 84 patients with severe craniocerebral injury in ICU were selected and divided into observation group and control group by table of random number,with 42 patients in either group. Both two groups were given routine medical treatments,such as intracranial pressure control,antibiotics,stomach lining protection,brain cells nutrition etc,and enteral nutrition suspension 2000-2500 m L / d at an infusion speed of 100 m L / h. The observation group was additionally given 0. 5 g Compound Lactobacillus acidophilus Tablets,which were ground and melt in warm boiled water and then injected by stomach tube,three times a day for 10 days. The GCS,SOFA and APACHE scores,serum albumin( ALB),hemoglobin( Hb) and intestinal tract s Ig A levels of patients in both groups before and 10 days after the treatment were observed and recorded. Results After 10 days’ treatment,the GCS score of patients in both groups increased,however,the SOFA and APACHE scores declined( P < 0. 05 or P < 0. 01),with the increasing and declining values of patients in observation group much higher than those in control group( P < 0. 05). The ALB and Hb levels of patients in both groups declined( P < 0. 05 or P < 0. 01),with the declining rate in observation group much lower than that in control group( P < 0. 05). Meanwhile,the intestinal s Ig A level of patients in observation group obviously rose than before( P < 0. 05),while that of patients in control group showed no obvious changes after the treatment( P <0. 05). Conclusion Compound Lactobacillus acidophilus Tablets combined with early enteral nutrition has reliable curative effect on severe craniocerebral injury,which can increase GCS score,decrease SOFA and APACHE scores,slow down the declining rates of ALB and Hb levels,improve the nutritional status,raise the intestinal s Ig A level and enhance local intestinal mucosal immunity.更多还原