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目的观察益生菌联合早期肠内营养对重型颅脑损伤患者感染的影响。方法选取重型颅脑损伤患者38例,按随机数字表分为研究组(17例)和对照组(21例)。2组患者均在入院后24～72 h内开始经鼻胃管行肠内营养,研究组在肠内营养基础上添加益生菌。于肠内营养开始后1、4、7、15 d晨空腹抽血监测白细胞、淋巴细胞、C-反应蛋白等指标,记录患者感染发生时间、严重程度,观察患者预后情况,比较ICU住院天数和GCS、SOFA、APACHEⅡ评分。结果研究组白细胞计数在营养后7 d显著低于对照组(P<0.05),C-反应蛋白在15 d显著低于对照组(P<0.05),而淋巴细胞计数在各时相点两组差异均无统计学意义(P>0.05)。研究组总感染发生率、肺部感染发生率也显著低于对照组(P<0.05),其ICU住院天数明显降低(P<0.05)。在营养第15天,研究组GCS评分显著高于对照组(P<0.05)。结论与单纯早期肠内营养相比,添加益生菌能更好地降低重型颅脑损伤患者的感染发生率,缩短ICU住院天数,改善患者的预后。
Objective To observe the effect of probiotics combined with early enteral nutrition on infection in patients with severe craniocerebral injury. Methods Thirty-eight patients with severe craniocerebral injury were selected and randomly divided into study group (n = 17) and control group (n = 21). Both groups started enteral nutrition via nasogastric tube within 24-72 h after admission. The research group added probiotics on the basis of enteral nutrition. Blood samples were collected at 1, 4, 7, 15 d after enteral nutrition for fasting blood to monitor leukocyte, lymphocyte and C-reactive protein. The time and severity of infection were recorded. The prognosis of patients was observed. GCS, SOFA, APACHE Ⅱ score. Results The leukocyte count in the study group was significantly lower than that in the control group on the 7th day after nutrition (P <0.05), while the level of C-reactive protein in the study group was significantly lower than that of the control group on the 15th day (P <0.05) There was no significant difference (P> 0.05). The incidence of total infection and pulmonary infection in the study group was also significantly lower than that in the control group (P <0.05), and the length of hospital stay in the ICU was significantly decreased (P <0.05). On the 15th day of nutrition, GCS score of the study group was significantly higher than that of the control group (P <0.05). Conclusion Compared with simple early enteral nutrition, adding probiotics can reduce the incidence of infection in patients with severe craniocerebral injury, shorten the length of stay in ICU and improve the prognosis of patients.