作者：吴鹏，颜秀侠，韩若东，李博文，汤成，张亚飞

单位：

236800安徽省亳州市人民医院重症医学科二病区

Units：

The Second Inpatient Area, Department of Critical Care Medcine, the People's Hospital of Bozhou, Bozhou 236800, China

关键词：

颅内出血，高血压性；高血压脑出血；营养支持；幽门；治疗结果

Keywords：

Intracranial hemorrhage, hypertensive; Hypertensive cerebral hemorrhages; Nutritional support; Pylorus;Treatment outcome

CLC：

R 743.34

DOI：

10.12114/j.issn.1008-5971.2022.00.218

Funds：

摘要：

目的　探讨术后早期幽门后肠内营养支持治疗重症高血压脑出血（HICH）的效果。方法　选取2018—2021年于亳州市人民医院行颅内血肿清除术的重症HICH患者81例为研究对象。采用随机数字表法将患者分为对照组（41例）和试验组（40例）。两组患者于颅内血肿清除术后早期（12~72 h）进行营养支持，其中试验组采用幽门后肠内营养支持，对照组采用鼻胃管肠内营养支持。比较两组干预前（T0）、干预3 d（T1）、干预7 d（T2）及干预2周（T3）时营养状况指标〔总蛋白（TP）、白蛋白（ALB）、血红蛋白（Hb）、前白蛋白（PAB）〕、肠道菌群（双歧杆菌、肠球菌、大肠埃希菌）数量、免疫指标（CD3+ T淋巴细胞分数、CD4+ T淋巴细胞分数、CD4+/CD8+ T淋巴细胞比值）、美国国立卫生研究院卒中量表（NIHSS）评分、急性生理学及慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分及不良反应发生情况。结果　治疗方法与时间在TP、ALB、Hb、PAB、双歧杆菌数量、肠球菌数量、大肠埃希菌数量、CD3+ T淋巴细胞分数、CD4+ T淋巴细胞分数、CD4+/CD8+ T淋巴细胞比值、NIHSS评分、APACHE Ⅱ评分上存在交互作用（P ＜0.05）；治疗方法、时间在TP、ALB、Hb、PAB、双歧杆菌数量、肠球菌数量、大肠埃希菌数量、CD3+ T淋巴细胞分数、CD4+ T淋巴细胞分数、CD4+/CD8+ T淋巴细胞比值、NIHSS评分、APACHE Ⅱ评分上主效应显著（P ＜0.05）。试验组T2、T3时TP、ALB、Hb、PAB、双歧杆菌数量、CD3+ T淋巴细胞分数、CD4+ T淋巴细胞分数、CD4+/CD8+ T淋巴细胞比值高于对照组，肠球菌数量、大肠埃希菌数量、NIHSS评分、APACHE Ⅱ评分低于对照组（P ＜0.05）。试验组T1时TP、ALB、Hb、PAB、双歧杆菌数量、CD3+ T淋巴细胞分数、CD4+ T淋巴细胞分数、CD4+/CD8+ T淋巴细胞比值高于T0时，肠球菌数量、大肠埃希菌数量、NIHSS评分、APACHE Ⅱ评分低于T0时（P ＜0.05）；对照组、试验组T2、T3时TP、ALB、Hb、PAB、双歧杆菌数量、CD3+ T淋巴细胞分数、CD4+ T淋巴细胞分数、CD4+/CD8+ T淋巴细胞比值分别高于本组T0、T1时，肠球菌数量、大肠埃希菌数量、NIHSS评分、APACHE Ⅱ评分分别低于本组T0、T1时（P ＜0.05）；对照组、试验组T3时TP、ALB、Hb、PAB、双歧杆菌数量、CD3+ T淋巴细胞分数、CD4+ T淋巴细胞分数、CD4+/CD8+ T淋巴细胞比值分别高于本组T2时，肠球菌数量、大肠埃希菌数量、NIHSS评分、APACHE Ⅱ评分分别低于本组T2时（P ＜0.05）。两组不良反应发生率比较，差异无统计学意义（P ＞0.05）。结论　术后早期幽门后肠内营养支持能有效改善重症HICH患者的营养状况，纠正道菌群失调状态，改善免疫功能和神经功能，减轻病情严重程度，且安全性好，有利于患者术后的恢复。

Abstract：

Objective　To investigate the effect of early postoperative post-pyloric enteral nutrition support in thetreatment of severe hypertensive intracerebral hemorrhage (HICH) . Methods　A total of 81 patients with severe HICH whounderwent intracranial hematoma evacuation in Bozhou People's Hospital from 2018 to 2021 were selected as the researchsubjects. The patients were divided into control group (41 cases) and experimental group (40 cases) by random number tablemethod. Nutritional support was given to patients in the early stage (12-72 h) after removal of intracranial hematoma. Theexperimental group was given post-pyloric enteral nutrition support, and the control group was given nasogastric tube enteralnutrition support. The nutritional status indicators [total protein (TP) , albumin (ALB) , hemoglobin (Hb) , prealbumin (PAB) ] ,intestinal flora (Bifidobacterium, Enterococcus, Escherichia coli) number, immune indicators (CD3+ T lymphocyte fraction, CD4+T lymphocyte fraction, CD4+/CD8+ T lymphocyte ratio) , National Institutes of Health Stroke Scale (NIHSS) score and AcutePhysiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score before intervention (T0) , 3 days after intervention (T1) , 7 daysafter intervention (T2) and 2 weeks after intervention (T3) and adverse reactions were compared between the two groups. Results　There was interaction between treatment method and time on TP, ALB, Hb, PAB, Bifidobacterium number, Enterococcus number,Escherichia coli number, CD3+ T lymphocyte fraction, CD4+ T lymphocyte fraction, CD4+/CD8+ T lymphocyte ratio, NIHSS scoreand APACHE Ⅱ score (P < 0.05) . The main effect of treatment method and time on TP, ALB, Hb, PAB, Bifidobacterium number,Enterococcus number, Escherichia coli number, CD3+ T lymphocyte fraction, CD4+ T lymphocyte fraction, CD4+/CD8+ T lymphocyteratio, NIHSS score and APACHE Ⅱ score was significant (P < 0.05) . At T2 and T3, TP, ALB, Hb, PAB, Bifidobacterium number,CD3+ T lymphocyte fraction, CD4+ T lymphocyte fraction, CD4+/CD8+ T lymphocyte ratio in the experimental group were higherthan those in the control group, while the number of Enterococcus and Escherichia coli, NIHSS score and APACHE Ⅱ scorewere lower than those in the control group (P < 0.05) . In the experimental group, TP, ALB, Hb, PAB, Bifidobacterium number,CD3+ T lymphocyte fraction, CD4+ T lymphocyte fraction, CD4+/CD8+ T lymphocyte ratio at T1 were higher than those at T0, whilethe number of Enterococcus and Escherichia coli, NIHSS score and APACHE Ⅱ score were lower than those at T0 (P < 0.05) .In the control group and the experimental group, TP, ALB, Hb, PAB, Bifidobacterium number, CD3+ T lymphocyte fraction, CD4+T lymphocyte fraction, CD4+/CD8+ T lymphocyte ratio at T2 and T3 were higher than those at T0 and T1, while the number ofEnterococcus and Escherichia coli, NIHSS score and APACHE Ⅱ score were lower than those at T0 and T1, respectively (P <0.05) . In the control group and the experimental group, TP, ALB, Hb, PAB, Bifidobacterium number, CD3+ T lymphocyte fraction,CD4+ T lymphocyte fraction, CD4+/CD8+ T lymphocyte ratio at T3 were higher than those at T2, while the number of Enterococcus andEscherichia coli, NIHSS score and APACHE Ⅱ score were lower than those at T2, respectively (P < 0.05) . There was no significantdifference in the incidence of adverse reactions between the two groups (P > 0.05) . Conclusion　Early postoperative post-pyloricenteral nutrition support can effectively improve the nutritional status of patients with severe HICH, correct intestinal floraimbalance, improve immune function and neurological function, reduce the severity of the disease, and has good safety, which isconducive to the recovery of patients after surgery.

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