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Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes
- Affiliations：
1. 145Department of Neurological Intensive Care Unit, 4Department of Neurosurgery, 5Department of Geriatric Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China
2. 2Community Medical Service Center of Shuiqinggou Street, Qingdao, Shandong 266042, China
3. 3Nursing School, Medical College of Qingdao University, Qingdao, Shandong 266003, China
- Author bio：
*Corresponding author Tel: 86-532-82912326, E-mail: fanmcchina@126.com
- Funds：△Supported by the Natural Science Foundation of Shandong province (Y2008C35) and Technology Supporting Program of Qingdao (12-1-3-5-(1)-nsh).
DOI：
中图分类号：-
网络出版日期：2016-08-20，
纸质出版日期：2016-08
- Accepted：
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Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes[J]. 中国医学科学杂志（英文版）, 2016,31(4):213-220.
Fan Ming-chao, Wang Qiao-ling, Fang Wei, et al. Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes△[J]. Chinese medical sciences journal, 2016, 31(4): 213-220.
Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes[J]. 中国医学科学杂志（英文版）, 2016,31(4):213-220. DOI：
Fan Ming-chao, Wang Qiao-ling, Fang Wei, et al. Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes△[J]. Chinese medical sciences journal, 2016, 31(4): 213-220. DOI：
摘要
Abstract
Objective
To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN) with single EN or PN on immune function
nutritional status
complications and clinical outcomes of patients with severe traumatic brain injury (STBI).
Methods
A prospective randomized control trial was carried out from January 2009 to May 2012 in Neurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow Coma Scale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were admi- nistrated EN
PN or EN+PN treatments respectively. The indexes of nutritional status
immune function
complications and clinical outcomes were examined and compared statistically.
Results
There were 120 patients enrolled in the study
with 40 pationts in each group. In EN+PN group
T lymthocyte subsets CD3+%
CD4+%
ratio of CD3+/CD25+
ratio of CD4+/CD8+
the plasma levels of IgA
IgM
and IgG at 20 days after nutritional treatment were significantly increased compared to the baseline(
t
=4.32-30.00
P
<
0.01)
and they were significantly higher than those of PN group (
t
=2.44-14.70;
P
<
0.05
or
P
<
0.01) with exception of CD4+/CD8+
higher than those of EN group (
t
=2.49-13.31
P
<
0.05
or
P
<
0.01) with exceptions of CD3+/CD25+
CD4+/CD8+
IgG and IgM. For the nutritional status
the serum total protein
albumin
prealbumin and hemoglobin were significantly higher in the EN (
t
=5.87-11.91;
P
<
0.01) and EN+PN groups (
t
=6.12-13.12;
P
<
0.01) than those in PN group after nutrition treatment. The serum prealbumin was higher in EN+PN group than that in EN group (
t
=2.08;
P
<
0.05). Compared to the PN group
the complication occurrence rates of EN+PN group were significantly lower in stress ulcer (22.5%
vs
. 47.5%;
χ
2
= 8.24
P
<
0.01)
intracranial infection (12.5% vs 32.5%;
χ
2
= 6.88
P
<
0.01) and pyemia (25.0%
vs
. 47.5%;
χ
2
= 6.57
P
<
0.05). Compared to the EN group
the complication occurrence rates of EN+PN group were significantly lower in aspirated pneumonia (27.5%
vs
. 50.0%;
χ
2
= 6.39
P
<
0.05)
hypoproteinemia (17.5%
vs
. 55.0%;
χ
2
= 18.26
P
<
0.01) and diarrhea (20.0%
vs
. 60.0%;
χ
2
= 20.00
P
<
0.01). The EN+PN group also had significant less length of stay in NICU (
t
=2.51
4.82;
P<
0.05
P<
0.01)
number of patients receiving assisted mechanical ventilation (
χ
2
= 6.08
12.88;
P
<
0.05
P<
0.01) and its durations (
t
=3.41
9.08;
P
<
0.05
P<
0.01)
and the death rate (
χ
2
=7.50
16.37;
P
<
0.05
P<
0.01) than those of EN or PN group.
Conclusion
Early EN+PN treatment could promote the recovery of the immune function
enhance nutritional status
decrease complications and improve the clinical outcomes in patients with severe traumatic brain injury.
关键词
Keywords
references
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