| PurposeThrough the prospective,randomized controlled study,we compared the effects of early enteral nutrition in patients with severe craniocerebral injury by spiral nasointestinal tube and nasogastric tube intubation,such as improving the energy intake of patients with severe craniocerebral injury and reducing the occurrence and development of pulmonary infection.,reducing the expression of inflammatory response,and improve their immunity.To provide effective guidance for the clinical diagnosis,treatment and prognosis of patients with severe craniocerebral injury.MethodForty-nine patients with acute severe craniocerebral injury were collected who hospitalized in the Second Affiliated Hospital of Fujian Medical University neurosurgery from October 2015 ~ September 2016.Forty-nine patients were randomly divided into spiral nasal intestine group and nasogastric tube group according to the random number table method.The two groups were routinely treated with dehydration and lowering blood pressure,nutrition nerve,maintaining water and electrolyte balance and supplement Vitamins and other drug treatment,the implementation of the same nutritional agents by different nasal feeding pathways,to establish a sound medical records and regular assessment of the patient situation.Enteral Nutritional Emulsion(TPF-T)(trade name: Rui Neng,Huarui Pharmaceutical Co.,Ltd.)was uniform continuous nutrient pumped from the nasal bowel and nasogastric tube group at 24 to 48 hours after admission,and 45 healthy blood samples were taken as healthy groups.To detect and evaluate the incidence of pulmonary infection and to detect the infection index(procalcitonin PCT)I in the 1st d,3rd d、7th d、14th d after enteral nutrition.Regular detection the levels of CD3 +,CD4 +,CD8 +,CD4 + / CD8 + in the serum of patients.Serum levels of TNF-α and IL-6 were measured by enzyme-linked immunosorbent assay(ELISA).Serum CRP levels were measured by immunoturbidimetry.The GCS score,APACHEII score and 1 Monthly follow-up mortality of the patients in two groups were compared.Result1.The cumulative occurrence number of lung infections in the nasointestinal tube group was 0,5,9 and 14 cases on the 1st d,3rd d、7th d、14th d,respectively.The cumulative occurrence number of lung infections in the nasogastric tube group was 0,8,18 and 26 cases on the 1st d,3rd d、7th d、14th d,respectively.The cumulative occurrence number of pulmonary infection in the nasogastric tube group was significantly higher than that of nasointestinal tube group on 14 th d,among them the difference of the 7th d、14th d was statistically significant(P <0.05).With the extension of nasogastric feeding time,the rate of pulmonary infection in the nasogastric tube group was significantly faster than that in the nasointestinal tube group.The concentration of PCT in the serum of patients in nasointestinal tube group and nasogastric tube group were 0.34 ± 0.13 and 0.32 ± 0.08,0.85 ± 0.25 and 1.15 ± 0.32,1.56 ± 0.38 and 1.98 ± 0.42,1.34 ± 0.43 and + 1.55 ± 0.51,respectively on the 1st d,3rd d、7th d、14th d,and the differences of the 3rd d、7th d and 14 th d was statistically significant(P <0.05).2.The levels of serum CD3 + in the nasointestinal tube group and nasogastric tube group were 53.16 ± 8.10 and 52.38 ± 7.95,57.85 ± 4.21 and 56.63 ± 5.38,64.85 ± 3.15 and 60.98 ± 4.10,68.31 ± 3.38 and 62.38± 3.20,respectively on the 1st d,3rd d、7th d、14th d.The levels of serum CD4 + in the nasointestinal tube group and nasogastric tube group were 26.89 ± 4.73 and 26.43 ± 5.80,32.15 ± 2.98 and 31.37 ± 3.50,37.85 ± 4.39 and 33.58 ± 3.52,42.18 ± 4.85 and 37.78± 3.47,respectively on the 1st d,3rd d、7th d、14th d.The levels of serum CD8 + in the nasointestinal tube group and nasogastric tube group were 21.54 ± 5.65 and 21.43±5.34,23.17± 7.12 and 22.89± 6.38,21.90± 4.10 and 23.00± 3.84,22.80 ± 5.29 and 23.10± 3.95,respectively on the 1st d,3rd d、7th d、14th d.The levels of serum CD4+ /CD8+in the nasointestinal tube group and nasogastric tube group were 1.24 ± 0.21 and 1.23 ±0.29,1.38 ± 0.45 and1.37 ± 0.48,1.72 ± 0.74 and 1.46 ± 0.41,1.85 ± 0.63 and 1.63± 0.39,respectively on the 1st d,3rd d、7th d、14th d.The levels of CD3 +,CD4 +,CD4 + /CD8 + in the nasointestinal tube group were significantly higher than those in the nasogastric tube group,there was no significant difference between the 1st d and the 3rd d(P> 0.05)and the difference was statistically significant between the 7th d and the 14 th d(P < 0.05).There was no significant difference in serum CD8 + between the two groups(P> 0.05).3.The levels of TNF-α in the serum of patients in the nasointestinal tube group and nasogastric tube group were 1.69 ± 0.38 and 1.78 ± 0.42,2.58 ± 0.52 and 2.60 ± 0.49,2.01± 0.37 and 2.21 ± 0.45,1.33 ± 0.29 and 1.58 ± 0.32.The levels of IL-6 in the serum of patients in the nasointestinal tube group and nasogastric tube group were 120.49 ± 10.40 and 122.38 ± 11.90,178.62 ± 10.35 and 182.70 ± 12.50,119.82± 12.70 and 137.49 ± 13.20,42.50 ± 8.32 and 68.50± 9.51.The levels of CRP in the serum of patients in the nasointestinal tube group and nasogastric tube group were 48.96 ± 4.50 and 49.35 ± 4.80,63.75 ± 5.95 and 64.80 ±6.30,35.60± 3.72 and 42.85 ± 3.95,16.30 ± 1.85 and 21.35 ± 1.98.The levels of TNF-α,IL-6 and CRP inflammatory factor in the serum of the two groups were significantly increase in the first day after injury,at the peak of the 3rd day after injury,the difference was not statistically significant(P <0.05).On the 7th day,the index of inflammatory factors decreased gradually in the two groups,and the decrease of nasointestinal tube group was more obvious than that of nasogastric tube group.There was significant difference between the two groups on the 7th day and the 14 th day(P <0.05).4.On the 14 th day of treatment,GCS score of nasointestinal tube group(10.80 + 1.38)was higher than that of the nasogastric tube group(9.20±1.24);while the corresponding APACHE II score(8.20 ± 1.12)of nasointestinal group was lower than that of the nasogastric tube(10.00 ± 1.32),the difference was statistically significant(P <0.05).Follow up after 1 months,suggesting that the mortality rate of nasointestinal tube group was lower than that of nasogastric tube group,the difference was not statistically significant(P> 0.05).Conclusion1.Compared with nasogastric tube enteral nutrition,the spiral nasointestinal tube nutrition can reduce the risk of lung infection,and with the nasal feeding time is more conducive to reduce the further development of lung infection.2.Compared with nasogastric tube enteral nutrition,the level of TNF-α,IL-6 and CRP in serum can be significantly reduced by the intubation of spiral nasointestinal tube nutrition,which can reduce the expression of inflammatory reaction and promote the recovery of the body.3.Compared with nasogastric tube enteral nutrition,the spiral nasointestinal tube nutrition can increase the energy intake,improve their body immunity.4.Compared with nasogastric tube enteral nutrition,the spiral nasointestinal tube nutrition can improve the GCS score,reduce APACHE II score,improve the prognosis of patients. |
PDF Full Text Request