Influence Of Early Enteral Nutrition With Added Probiotics On Serum Inflammatory Factors And Intestinal Mucous Membrane Barrier Function Of Patients With Severe Brain Injury

Background:Enteral nutrition support therapy is an important part of comprehensive treatments of critically ill patients.And it is an important auxiliary treatment for severe craniocerebral injury patients.Numerous clinical studies have shown that the enteral nutrition can improve the intestinal mucosal barrier function,promote the recovery of intestinal peristalsis,and provide the necessary nutrients like glutamine etc.,to improve the prognosis of critically ill patients.The nutrition guidelines for critically ill patients released on February 2016 by SCCM/ASPEN pointed out that enteral nutrition is the first choice nutrition support for critically ill patients and that the early enteral nutrition is recommended(within 24 to 48 hours).This tells us enteral nutrition,especially early open enteral nutrition,plays an important role in the treatment of critically ill patients.This tells us that enteral nutrition,especially early open enteral nutrition,have an important effect on the treatment of critically ill patients.Probiotics are a class of active microbes that are beneficial to the host.It can correct intestinal flora disorders,repair the gastrointestinal mucosal barrier and increase immunity and other functions.But the reports of combination of early enteral nutrition and probiotics for craniocerebral injury patients are rare.IL-6 and TNF-a are inflammatory mediators that reflect systemic inflammatory response.D lactic acid and PCT can reflect the degree of intestinal mucosal damage and the changes of permeability of the intestinal mucosa.In this study,we selected IL-6 and TNF-a as serum inflammatory factors and selected D lactate and PCT reflecting intestinal mucosal barrier function.To observe the effect of early enteral nutrition supplemented with probiotics on serum inflammatory factors and intestinal mucosal barrier function in patients with severe craniocerebral injury.Objective:To discuss the influence of early enteral nutrition with added probiotics on serum inflammatory factors and intestinal mucous membrane barrier function of patients with severe brain injury.Methods:Eighty patients with severe craniocerebral injury were randomly divided into observation group(n = 40 cases)and control group(n = 40 cases)by prospective study.The two groups of patients after admission or after surgery were given therapy of controlling intracranial pressure and blood pressure,preventing infection,protecting the gastric mucosa and providing nutrition for brain cells and other basic treatment.The patients had no contraindications and were in hemodynamic stability.The control group was given early enteral nutrition(within 24 to 48 hours)through nasogastric tube.The Enteral Nutritional Suspension(SP)was continuously pumping into the patients’stomach.The speed started at 20-25 mL/h.The total amount was controlled at 500ml per day.If there was no serious gastrointestinal reaction,we would speed up to 60-85mL/h,1500-2000ml per day within 48 to 72 hours.The observation group on the basis of enteral nutrition was added Bifid Triple Viable Capsules Dissolving at Intestines 630mg.The capsules were grinding and hydration,and were feeding the patients through nasogastric tube three times a day,for 14 days.The GCS scores and the levels of serum inflammatory factors(interleukin(IL)-6,tumor necrosis factor(TNF)-α)and gastrointestinal mucosal barrier function(D-lactate and procalcitonin PCT)were measured before and after 14 days treatments.Result:After 14 days of treatment,the GCS scores of the two groups were significantly higher than before(P<0.05 or P<0.01).And the GCS scores of the observation group increased more significantly than that of the control group(P<0.05).At the same time,the levels of serum inflammatory factors like IL-6 and TNF-α were decreased significantly(P<0.05 or P<0.01).And the the levels of the observation group were decreased more significantly(P<0.05)than the levels of the control group.Meanwhile,the levels of serum D-lactate and PCT were decreased significantly in both groups(P<0.05 或 P<0.01),and the levels of the observation group were decreased more significantly(P<0.05).Conclusions:Early enteral nutrition supplementation with probiotics can improve GCS score,decrease the levels of serum inflammatory factors like IL-6 and TNF-α,inhibit the body’s inflammatory response,decrease the levels of serum D-lactate and PCT,protect and repair the gastrointestinal mucosal barrier function and improve the gastrointestinal function in patients with severe craniocerebral injury.