【摘要】 目的:探讨老年重症高血压脑出血(HIH)患者肠外营养(PN)的介入时机。方法:120例HIH患者,随机分为A(早期肠内营养组, EN组)、B组(早期肠内营养+24～48h肠外营养组)及C组(早期肠内营养+5～7d肠外营养组)3组,每组40例。比较观察各组胃肠道反应,并通过检测患者血二胺氧化酶(DAO)及血内毒素(ET)水平,观察不同营养方式对患者肠道屏障的影响;检测患者血清蛋白水平。结果:C组患者住院时间较A组、B组显著减少[12.18±2.02 vs 20.48±5.67、19.60±6.60 d,P<0.05];B组患者的感染及胆汁淤积发生率显著高于A、C组[6例(15.00%)vs 3例(7.50%)、2例(5.00%),P<0.05],但低血糖的发生率显著低于A、C组[2例(5.00%)vs 5例(12.50%)、5例(12.50%),P<0.05]。与A组比较,治疗第14d,B、C组患者血清前白蛋白及视黄醇结合蛋白水平均显著升高(P<0.05)。此外,以检出血清内毒素水平≥0.1EU/ml为阳性,治疗第14d A、B、C组患者中阳性的比例分别为4(10.00%)、5(12.50%)和1(2.50%),C组低于A、B组,差异有统计学意义(P<0.05)。结论:对于存在营养风险的老年重症HIH患者,在早期EN的基础上,联合延迟(5～7d)肠外营养的治疗策略,较单纯EN、EN+早期PN更有利于改善患者的营养指标及免疫功能,感染更少、恢复更快。更多还原

【Abstract】 Objective: To explore the timing of intervention for parenteral nutrition(PN) in elderly patients with severe hypertensive intracerebral hemorrhage(HIH). Methods: 120 patients with HIH were randomly divided into 3 groups, group A(early enteral nutrition group,EN group), group B(early enteral nutrition+24～48 h parenteral nutrition group) and group C(early enteral nutrition+5～7 d parenteral nutrition group), with 40 cases in each group. The effects of diamine oxidase(DAO) and blood endotoxin on the intestinal barrier of the patients were observed and the serum albumin were detected. Results: The time of hospitalization in group C was significantly lower than that in group A and group B, [12.18±2.02 vs 20.48±5.67, 19.60±6.60 d, P<0.05], the incidence of infection and cholestasis in B group was significantly higher than group A, group C [6 cases(15%) vs 3 cases(7.50%), 2 cases(5%)], but the incidence of hypoglycemia was significantly lower than that of those [2 cases(5%) vs 5 cases(12.50%), 5 cases(12.50%), P<0.05]. Compared with group A, the levels of serum prealbumin and retinol binding protein on the 14 d, B and C groups increased significantly(P<0.05). In addition, that serum endotoxin level(≥0.1 EU/ml) was positive, the positive proportion in group A, B and C on the 14 d was 4(10%), 5(12.50%) and 1(2.50%), the positive proportion in group C was lower than that of in A and B group, the difference was statistically significant(P<0.05). Conclusion: For the elderly patients with severe HIH and nutritional risk, on the basis of early EN, the treatment strategy of combined delayed(5～7 d) parenteral nutrition is more beneficial to improve the nutritional index and immune function of the patients than the simple EN and EN+ early PN, with less infection and faster recovery.更多还原