目的  本研究旨在探讨不同俯卧位通气（PPV）时间对重症肺炎合并胃肠功能障碍患者肠内营养耐受性的影响。方法  选择2020年7月—2023年7月在天津市人民医院重症监护病房（MICU）治疗的80例重症肺炎合并胃肠功能障碍患者为研究对象, 按每日PPV时间分为长时组（≥12 h, n=40）和短时组（<12 h, n=40）。比较两组患者一般资料、氧合指数、胃肠功能指标[腹内压、血清促胃液素（GAS）和血管活性肠肽（VIP）]、肠内营养达标率、胃肠并发症率等。结果  短时组治疗后, 1 d、3 d、5 d氧合指数为（189.93±33.72）、（247.53±63.01）、（325.03±58.11）mmHg,高于长时组的（161.63±36.88）、（191.83±57.65）、（267.95±46.25）mmHg,均P<0.05; 胃残留量为（29.00±7.92）、（19.75±4.45）、（11.00±1.87） mL低于长时组的（75.03±23.29）、（53.13±11.99）、（21.70±5.52） mL, 均P<0.05。短时组治疗后腹内压[（8.53±2.05）mmHg vs （9.75±2.05） mmHg]、VIP水平[（61.14±7.63） vs （67.49±4.43） pg/mL]低于长时组,GAS水平[（65.02±8.84） vs （54.22±9.21）pg/mL]升高（均P<0.05）。短时组总胃肠并发症发生率（7.50%）低于长时组（25.00%）, P=0.034。结论  对于重症肺炎合并胃肠功能障碍患者,每日PPV时间≤12 h可改善氧合并降低胃肠并发症风险, 可能与减轻腹压、调节胃肠激素分泌及提升肠内营养耐受性相关。

      Objective To explore the effect of different duration of prone position ventilation（PPV）on enteral nutritional tolerance in patients with severe pneumonia combined with gastrointestinal dysfunction．Methods A total of 80 patients with severe pneumonia complicated by gastrointestinal dysfunction were treated in the Medical Intensive Care Unit（MICU）of a hospital from July 2020 to July 2023, and were selected as the research subjects．They were divided into the long-duration group（≥12 hours, n=40）and the short-duration group（<12 hours, n=40）according to the daily duration of PPV．The general data, oxygenation index, gastrointestinal function indicators（intra-abdominal pressure, serum gastrin[GAS] and vasoactive intestinal peptide[VIP]）, enteral nutrition achievement rate, and gastrointestinal complications of the two groups were compared．Results The oxygenation index of the short-duration group at 1 d, 3 d,a nd 5 d after treatment（[189.93±33.72], [247.53±63.01], and[325.03±58.11] mmHg, respectively）was significantly higher than that of the long-duration group（[161.63±36.88], [191.83±57.65], and[267.95±46.25] mmHg,respectively, all P<0.05）．The gastric residual volume of the short-duration group（[29.00±7.92], [19.75±4.45], and[11.00±1.87] mL, respectively）was significantly lower than that of the long-duration group（[75.03±23.29], [53.13±11.99], and[21.70±5.52] mL, respectively, all P<0.05）．The intra-abdominal pressure（[8.53±2.05] vs [9.75±2.05] mmHg）and VIP level（[61.14±7.63] vs [67.49±4.43] pg/mL）of the short-duration group after treatment were significantly lower than those of the long-duration group, while the GAS level（[65.02±8.84] vs [54.22±9.21] pg/mL）was significantly higher（all P<0.05）．The total incidence of gastrointestinal complications in the short-duration group（7.50%）was significantly lower than that in the long-duration group（25.00%, P=0.034）．Conclusions For patients with severe pneumonia complicated by gastrointestinal dysfunction, a daily duration of PPV within 12 hours can improve oxygenation and reduce the risk of gastrointestinal complications, which may be related to the reduction of intra-abdominal pressure, regulation of gastrointestinal hormone secretion, and improvement of enteral nutrition tolerance． 

目的 探讨个体化肠内营养支持在胃肠术后早期应用的可行性及安全性。方法 选取2022年1月—12月安徽省亳州市中医院普通外科收治的胃肠手术患者100例。使用随机数字表法将患者随机为观察组和对照组,每组各50例。观察组在常规治疗基础上实施个体化肠内营养,持续7 d。对照组则接受术后常规处理。术后第7天测定实验室指标,并比较两组胃肠功能的恢复情况。结果 观察组术后肛门首次排气时间短于对照组[（55.41±19.63）h vs （81.46±19.39） h],前白蛋白水平高于对照组[（241.14±65.73）g/L vs（217.35±51.63）g/L],组间比较差异有统计学意义（P<0.05）。血清总蛋白水平[（70.55±18.89）g/L vs （68.16±20.05）g/L]、血清白蛋白水平[（53.22±17.76）g/L vs（50.76±18.54）g/L]、淋巴细胞计数[（1.60±0.54）×10⁹/L vs （1.56±0.55）×10⁹/L]以及肛门排便时间[（89.67±22.31）h vs （97.77±21.27）h ]在组间比较差异无统计学意义（P>0.05）。结论 根据个体情况在胃肠术后早期实施个体化的肠内营养支持是安全可行的,能够促进胃肠功能的快速恢复,从而改善患者的营养状况。

Objective To investigate the feasibility and safety of personalized enteral nutrition support during the early postoperative period of gastrointestinal surgery．Methods A total of 100 patients who underwent gastrointestinal surgery at the Department of General Surgery,Bozhou Hospital of Traditional Chinese Medicine,who were enrolled in this study during January 2022 to December 2022．Patients were randomly allocated into either the observational or control group,with 50 patients in each group．The randomization was performed using a random number table．The observational group received personalized enteral nutrition support in addition to routine treatment for 7 days．The control group received standard postoperative care．Laboratory indicators were measured on the 7th postoperative day to compare recovery of gastrointestinal function between the two groups．Results The observational group exhibited a significantly shorter time to the first passage of flatus from the anus compared to the control group（55.41±19.63 h vs 81.46±19.39 h,P<0.05）,as well as higher prealbumin levels（241.14±65.73 g/L vs 217.35±51.63 g/L,P<0.05）．However,there were no significant differences between the two groups in terms of serum total protein levels（70.55±18.89 g/L vs 68.16±20.05 g/L）,serum albumin levels（53.22±17.76 g/L vs 50.76±18.54 g/L）,lymphocyte counts[（1.60±0.54）×10⁹/L vs （1.56±0.55）×10⁹/L],and time to the first defecation from the anus（89.67±22.31 h vs 97.77±21.27 h）（all P>0.05）．Conclusions Personalized enteral nutrition support based on individual conditions is safe and feasible in the early postoperative period of gastrointestinal surgery．It can promote the rapid recovery of gastrointestinal function and improve patients' nutritional status．

目的 构建并验证机械通气患儿肠内营养支持发生误吸的风险预测模型。方法 回顾性分析中山市博爱医院2021年3月—2023年3月儿童重症监护病房330例行机械通气并进行肠内营养的患儿临床资料,通过二元Logistic回归,获取机械通气患儿肠内营养支持发生误吸的预测因素,绘制列线图模型,并进行模型评价及验证。结果 330例机械通气患儿中,104例患儿发生误吸、226例未发生误吸。两组患儿在意识状态、机械通气方式、管饲量、胃残留量、胃管置入深度、促胃动力药、镇静剂等方面对比差异具有统计学意义（P<0.05）。二元Logistic结果显示,胃残留量、机械通气方式、管饲量、意识状态、胃管置入深度、促胃动力药、镇静剂是机械通气患儿肠内营养支持发生误吸的影响因素（P<0.05）。建模组AUC为0.810（95%CI：0.760~0.860）,Hosmer-Lemesh结果显示,χ²=3.245,P=0.846;外部验证组AUC为0.873（95%CI：0.831~0.914）,Hosmer-Lemesh结果显示,χ²=3.567,P=0.875。建模组和训练组DCA曲线大部分落于Y=0上方。建模组与外部验证组校准曲线均与参考曲线高度贴合,预测概率与实际概率接近,校准度良好。结论 基于胃残留量、机械通气方式、管饲量、意识状态、胃管置入深度、促胃动力药、镇静剂等7项指标构建的风险预测模型具有一定的临床价值,可作为医护人员识别肠内营养机械通气误吸高危患儿的工具。

Objective To establish and verify the risk prediction model of enteral nutritional aspiration in children with mechanical ventilation．Methods The clinical data of 330 children who underwent mechanical ventilation and enteral nutrition in the PICU of Zhongshan Boai Hospital from March 2021 to March 2023 were retrospectively analyzed．The independent predictive factors of enteral nutrition support aspiration in children with mechanical ventilation were obtained by binary Logistic regression,and the nomographic model was drawn,and the model was evaluated and verified. Results Among 330 children with mechanical ventilation,104 had aspiration and 226 did not．There were statistically significant differences between the two groups in consciousness state,mechanical ventilation mode,tube feeding amount,gastric residual amount,gastric tube insertion depth,gastric motivity drugs,sedatives,etc.（P<0.05）．Binary Logistic results showed that gastric residual amount,mechanical ventilation mode,tube feeding amount,state of consciousness,depth of gastric tube insertion,gastric motonics and sedatives were the influential factors of enteral nutritional aspiration in children with mechanical ventilation（P<0.05）．The AUC of the modeling group was 0.810（95%CI：0.760-0.860）,and the Hosmer-Lemesh result showed that χ²=3.245,P=0.846．The AUC of the external verification group was 0.873（95%CI：0.831-0.914）,and the Hosmer-Lemesh result showed that χ²=3.567,P=0.875．The DCA curves of modeling group and training group mostly were above Y=0．The calibration curves of the modeling group and the external verification group are highly fit to the reference curves,and the prediction probability was close to the actual probability,and the calibration degree was good．Conclusion sThe risk prediction model based on 7 indexes,including stomach residual amount,mechanical ventilation mode,tube feeding amount,state of consciousness,depth of gastric tube insertion,gastric motivity drug and sedative,with certain clinical value,and can be used as a tool for medical staff to identify children at high risk of enteral nutritional mechanical aspiration．

目的 探讨超声监测导向下早期肠内营养（EEN）在重症脓毒血症（SS）有创通气（IV）患者中的应用效果。方法 选取2021年2月—2023年11月连州市人民医院收入的115例SS-IV患者,依据随机数字表法分为对照组（n=57）、超声监测组（n=58）。所有患者均予重症监护病房（ICU）综合治疗,在此基础上对照组实施临床经验的传统肠内营养（EN）干预,超声监测组实施超声监测导向下EEN干预,均监测至治疗结束。统计两组IV时间、ICU停留时间、EN达标时间、EN不耐受发生率、相关并发症发生率,比较干预前、EN结束时营养状况[白蛋白（ALB）、总蛋白（TP）、前白蛋白（PA）]、序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。结果 对照组剔除放弃治疗1例,死亡2例,纳入54例;超声监测组剔除放弃治疗1例,死亡1例,纳入56例。超声监测组EN达标时间[（40.18±8.46）h]、IV时间[（7.12±1.44）d]、ICU停留时间[（9.21±1.63）d]短于对照组[（46.03±10.15）h、（8.02±1.62）d、（10.18±1.54）d]（t=3.288、3.082、3.206,均P<0.05）。EN结束时超声监测组SS-IV患者血清ALB[（32.05±3.13）g/L]、TP[（65.36±3.62）g/L]、PA[（0.24±0.06）g/L]高于对照组[（30.28±2.24）g/L、（63.28±4.24）g/L、（0.21±0.05）g/L]（t=3.400、2.770、2.843,均P<0.05）。EN结束时超声监测组APACHEⅡ评分[（15.85±1.93）分]、SOFA评分[（7.42±1.64）分]低于对照组[（17.02±2.04）分、（8.35±2.03）分]（t=3.091、2.648,均P<0.05）。超声监测组EN不耐受发生率[12.50%（7/56）]低于对照组[29.63%（16/54）],超声监测组相关并发症发生率[8.93%（5/56）]低于对照组[24.07%（13/54）]（χ²=4.878、4.608,均P<0.05）。结论 超声监测导向下EEN干预应用于SS-IV患者,可改善患者病情与营养状况,降低EN不耐受及相关并发症发生风险,缩短恢复时间。

Objective To investigate the effect of ultrasound monitoring guided early enteral nutrition（EEN）in patients with severe sepsis（SS）and invasive mechanical ventilation（IV）．Methods A total of 115 SS-IV patients admitted to Lianzhou People's Hospital from February 2021 to November 2023 were randomly divided into control group（n=57）and ultrasound monitoring group（n=58）．All patients were given comprehensive treatment in intensive care unit（ICU）．On this basis,traditional enteral nutrition（EN）intervention with clinical experience was implemented in control group,and EEN intervention guided by ultrasonic monitoring was implemented in ultrasound monitoring group．All patients were monitored until the end of treatment．IV time,ICU stay time,EN compliance time,incidence of EN intolerance,and incidence of related complications were analyzed in the 2 groups．Nutritional status [albumin（ALB）,total protein（TP）,prealbumin（PA）],sequential organ failure assessment（SOFA）,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）were compared before intervention and at the end of EN．Results In control group,1 cases gave up,2 cases died,and 54 cases were included．In ultrasound monitoring group,1 case gave up,1 case died,and 56 cases were included．The EN compliance time [（40.18±8.46）h],IV time [（7.12±1.44）d] and ICU stay time [（9.21±1.63）d] of ultrasound monitoring group were shorter than those of control group [（46.03±10.15）h,（8.02±1.62）d,（10.18±1.54）d]（t=3.288,3.082,3.206,all P<0.05）．At the end of EN,serum ALB[（32.05±3.13）g/L],TP[（65.36±3.62）g/L],PA[（0.24±0.06）g/L] of SS-IV patients in ultrasound monitoring group were higher than those in control group [（30.28±2.24）g/L,（63.28±4.24）g/L,（0.21±0.05）g/L]（t=3.400,2.770,2.843,all P<0.05）．At the end of EN,APACHEⅡ scores [（15.85±1.93）points] and SOFA scores [（7.42±1.64）points] of ultrasound monitoring group were lower than those of control group [（17.02±2.04）points and（8.35±2.03）points]（t=3.091,2.648,all P<0.05）．The incidence of EN intolerance in ultrasound monitoring group [12.50%（7/56）] was lower than that in control group [29.63%（16/54）],and the incidence of related complications in ultrasound monitoring group [8.93%（5/56）] was lower than that in control group [24.07%（13/54）]（χ²=4.878,4.608,all P<0.05）．Conclusions EEN intervention guided by ultrasonic monitoring in SS-IV patients can improve the nutritional status of patients,reduce the risk of EN intolerance and related complications,shorten the recovery time,and reduce the progression of patients' disease．

目的 探讨个体化肠内营养联合电动起立床训练对老年脑卒中卧床患者器官功能的影响。方法 严格执行纳排标准后前瞻性选取2021年7月—2022年9月期间我院收治的97例老年脑卒中卧床患者作为研究对象,按照随机数字表法分为单一组48例给予脑卒中基础干预,联合组49例给予个体化肠内营养联合电动起立床训练干预,观察2组患者营养状况、肺功能指标以及心功能指标。结果 干预4周后,2组血清前蛋白、血清白蛋白、血红蛋白水平均上升且联合组高于单一组（P<0.05）;2组用力肺活量（FVC）、第1秒用力呼吸容积（FEV₁）、FEV₁/FVC均上升且联合组高于单一组（P<0.05）;联合组左心室收缩期内径、左室舒张末期内径低于单一组,联合组左心室射血分数高于单一组（P<0.05）。结论 个体化肠内营养联合电动起立床训练干预可有效改善老年脑卒中卧床患者营养状况及心肺功能,促进其机体功能的恢复。

目的 研究益生菌结合肠内营养(enteral nutrition,EN)干预纠正缺血急性脑梗死(acute cerebral infarction,ACI)患者肠道菌落紊乱的作用及对患者预后的影响。方法 将97例无法自主进食的ACI患者根据治疗方法不同分为观察组(采用益生菌结合EN进行营养支持)和对照组(单纯EN为营养支持)进行治疗,疗程30 d,比较2组肠道菌落生长情况、患者营养水平、临床疗效及预后。结果 治疗后,2组双歧杆菌、肠球菌、大肠杆菌数量先降低后升高,2相邻时间点之间差异显著(P<0.05),2组乳酸杆菌数量持续升高,观察组各时间点之间差异显著(P<0.05),对照组治疗第7 d开始有明显差异(P<0.05),且治疗第7 d后观察组双歧杆菌、肠球菌、大肠杆菌数量高于对照组,差异有统计学意义(P<0.05),治疗第14 d后,观察组乳酸杆菌数量高于对照组,差异有统计学意义(P<0.05);治疗后,观察组体质量指数(body mass index,BMI)、肱三头肌皮皱厚度(triceps skinfold thinkness,TSF)、上臂肌围(arm muscle circumference,AMC)及血红蛋白(hemoglobin,HB)明显降低(P<0.05),对照组BMI、TSF、AMC、HB、白蛋白(albumin,ALB)及三酰甘油(triglyceride,TG)均明显降低(P<0.05),且观察组BMI、TSF、AMC、HB、ALB及TG高于对照组,差异有统计学意义(P<0.05);观察组治疗过程中腹胀、腹泻发生率低于对照组,差异有统计学意义(P<0.05);治疗后2组APACHEⅡ评明显降低(P<0.05),且观察组APACHEⅡ评分低于对照组,差异有统计学意义(P<0.05);治疗后观察组日常生活活动能力(activities of daily life,ADL)评分高于对照组,ADL分级优于对照组,差异有统计学意义(P<0.05)。结论 益生菌结合EN治疗可有效纠正患者肠道菌落平衡,保护胃肠道功能,从而改善机体营养水平,提高ACI治疗效果,改善患者预后。

目的 探讨品管圈活动在降低使用肠内营养制剂患者肠内营养相关性腹泻发生率的应用效果。方法 由全科医学科的11名护士组成品管圈小组,按品管圈实施步骤首先确定“降低使用肠内营养制剂患者肠内营养相关性腹泻的发生率”为活动主题,对肠内营养患者发生腹泻的情况和护士对肠内营养相关性腹泻认知情况进行现状调查,分析引起肠内营养相关性腹泻的原因,制定并实施相应的整改措施。结果 开展品管圈活动后使用肠内营养制剂腹泻率由原来的50%降低到21.03%,两者差异有统计学意义(χ²=24.859,P＜0.001)。将肠内营养制剂加温到38 ℃～40 ℃输注的腹泻率为28.10%,在常温下20 ℃～29 ℃输注的腹泻率为14.5%,两者差异有统计学意义(χ²=7,P＜0.05),达到了目标值;开展品管圈后圈能力较开展前高,差异有统计学意义(P＜0.05)。结论 开展品管圈活动可有效降低使用肠内营养制剂患者相关性腹泻的发生率,同时增强护理人员质量管理能力。

Objective To investigate the efficacy of quality control circle(QCC) activities in reducing the incidence of enteral nutrition-related diarrhea in patients using enteral nutritionpreparations. Methods According to the QCC's steps, 11 nurses from general medicine department participated in the QCC group first determined the theme as:Reduce the incidence of enteral nutrition preparations correlated diarrhea in patients with enteral nutrition.The situation of diarrhea in patients with enteral nutrition and the cognition of nurses on enteral nutrition-related diarrhea were investigated, the causes of enteral nutrition-related diarrhea were analyzed, and corresponding corrective measures were formulated and implemented. Results After carrying out the QCC program, the incidence rate of enteral nutrition preparation-associated diarrhea decreased from 50% to 21.03%, the result indicated statistical significance(χ²=24.859,P＜0.001). The diarrheal rate for warmed enteral nutrition preparations at 38℃-40℃ was 28.10%, and for those under room temperature at 20℃-29℃ was 14.5%, the result of these two groups indicated statistical significance (χ²=7,P＜0.05),target number was achieved. The ability of quality control for the nurses are improved compared to that before QCC activity, noted statistical significance (P＜0.05). Conclusion QCC activity has effectively reduced the incidence of diarrhea in patients who use enteral nutrition preparations as well as enhance the management ability of nurses in providing quality care.

目的 观察早期经鼻肠内营养(ENEN)对中-重度急性胰腺炎(MSAP+SAP)患者的治疗效果。方法 回顾性分析2014年9月—2019年5月期间,广东药科大学附属第一医院消化内科收治的50例MSAP及SAP患者临床资料,根据患者营养支持治疗方式不同,将患者分为观察组(n=25)和对照组(n=25)。观察组患者采用ENEN治疗,对照组采用肠外肠内营养联合(PNEN)治疗。对比两组患者治疗后血清白蛋白(ALB)、血清前白蛋白(PA)、C-反应蛋白(CRP)、急性生理与慢性健康(APACHE Ⅱ)评分、序贯器官功能衰竭(SOFA)评分及多器官功能障碍综合征(MODS)发生率。结果 经过治疗后,观察组患者ALB水平、PA水平高于对照组,CRP水平低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者APACHE Ⅱ评分、SOFA评分低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者MODS发生率低于对照组,差异有统计学意义(P＜0.05)。结论 ENEN治疗MSAP及SAP患者可有效改善患者营养状态和健康状况,降低机体炎症反应,减少MODS发生率。

Objective To observe the effect of early nasal enteral nutrition(ENEN) on patients with moderate to severe acute pancreatitis(MSAP+SAP). Methods A retrospective analysis of the clinical data of 58 patients with(MSAP+SAP) admitted to the department of gastroenterology, the First Affiliated Hospital of Guangdong Pharmaceutical University from September 2014 to May 2019, according to the different nutritional support treatment methods, the patients were divided into observation groups(n=25) and control group(n=25). Patients in the observation group were treated with ENEN, and the control group was treated with Parenteral nutrition and enteral nutrition(PNEN). Serum albumin(ALB), serum prealbumin(PA), C-reactive protein(CRP), acute physiology and chronic health evaluation(APACHE II) score, sequential organ failure assessment(SOFA) score, and incidence of multiple organ dysfunction syndrome(MODS) were compared between the two groups. Results After treatment, the ALB and PA level of the observation group were higher than those of the control group, and the CRP level was lower than that of the control group, the difference was statistically significant(P<0.05). After treatment, the APACHE II score and SOFA score of the observation group were lower than those of the control group, and the difference was statistically significant(P<0.05). After treatment, the incidence of MODS in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion ENEN treatment of MSAP and SAP may effectively improve the nutritional status and health of patients, reduce the body's inflammatory response and reduce the incidence of MODS.

目的 运用传统中医药理论,用中西医结合的方法,探讨简便中药结合肠内营养(EN)的支持方式对胃肠道肿瘤术后营养状况和炎性反应的影响,及改善胃肠道功能的作用。方法 胃肠道肿瘤术后患者随机分为黄陈枳术汤结合肠内营养组(观察组)和单纯肠内营养组(对照组)作对比研究,观察两组病人营养支持前后营养指标视黄醇结合蛋白(RBP),血清白蛋白(ALB)及炎性指标C反应蛋白(CRP)的改善情况,观察两组病人恶心、呕吐、腹胀、腹泻等胃肠道症状发生情况。结果 营养支持后RBP,ALB均有升高,观察组病人营养支持后第7、14天RBP和ALB水平均高于对照组,CRP低于对照组,差异有统计学意义(P＜0.05)。两种病人均有胃肠道不良反应,但观察组胃肠道并发症发生率较低,差异有统计学意义(P＜0.05)。结论 黄陈枳术汤结合肠内营养的中西医结合营养支持方法能纠正胃肠道功能紊乱,提高营养支持疗效,对胃肠道肿瘤术后患者的RBP和ALB有提高作用,能降低CRP,减少炎性反应,促进患者快速康复,缩短住院时间。

Objective Using a combination of Chinese and western medicine, to explore the effect of Huang Chen Zhisu decoction combined with enteral nutrition on RBP/ALB/CRP of gastrointestinal tumor patients after surgery,and improve gastrointestinal disorders. Methods Postoperative patients of gastrointestinal tumor were randomized into Huangchen Zhisu decoction combined with enteral nutrition group(observation group)and enteral nutrition group(control group). The retinol-binding protein(RBP),albumin(ALB),C-reactive protein (CRP),gastrointestinal symptoms, adverse reaction were observed and recorded. Results After nutrition support, the level of ALB and RBP were both increased. The ALB and RBP of the observation group on the 7th and 14th day after nutrition support were higher than those of the control group.The CRP of the observation group on the 7th and 14th day after nutrition support were lower than the control group, (P<0.05).The rate of postoperative gastrointestinal disorder of the observation group was obviously lower (P<0.05). Conclusion Huangchen Zhisu decoction combined with enteral nutrition has remarkable effect,can enhance the ALB and RPB, reduce CRP. The effect was better than enteral nutrition only. It improves the nutritional status and immune function,helps to promote the resumption on of gastrointestinal function,and helps postoperative patient for a quicker recovery.

目的 探讨早期肠内营养集束治疗对重型颅脑损伤患者营养状态及体液免疫功能的影响。方法 42例重型颅脑损伤患者按病人住院号分为两组,单号延迟普通营养治疗组(PT组,21例),双号早期营养集束治疗组(JS组,21例)。于营养治疗开始的第1、7、14天观察营养相关指标、免疫功能指标和ICU住院时间,采用t检验进行统计分析。结果 ①JS组患者血清白蛋白、前白蛋白、血红蛋白与PT组比较均明显升高,有统计学意义(P＜0.05),且各营养指标较治疗前亦明显升高(P＜0.05)。②JS组患者IgG、IgM、IgA、外周淋巴细胞计数(TLC)与PT组比较均明显升高,有统计学意义(P＜0.05),并且较治疗前均有明显改善(P＜0.05)。③JS组患者在ICU的住院时间比PT组减少约1天,但两组比较无统计学意义(P＞0.05)。结论 重型颅脑损伤可出现营养不良和免疫功能下降,规范的早期肠内营养集束治疗可改善病人营养状况,提高体液免疫功能。

Objective To study the changes in the nutritional status and humoral immunity after early enteral-nutrition bundle treatment in patients with severe traumatic brain injury. Methods 42 patients with severe traumatic brain injury were randomly divided into two groups,i.e. delayed common nutrition group (PT- group,21 cases),and early bundle nutrition group(JS-group,21 cases). All cases were tested at day1, day 7,day 14 of nutrition treatment, for detecting the nutrition related index, humoral immune index and ICU monitoring time, T-test was used for datastatistical analysis. Results ①Compared with PT-group, the serum albumin,prealbumin and hemoglobin in JS-group were significantly higher(P＜0.05), also had significant increase compared with before treatment in JS-group (P＜0.05). ②The serum levels of IgG, IgM, IgA and total lymphocyte count(TLC) were significantly higher in JS-group than those in PT-group(P<0.05), and significantly improved compared with before treatment in JS-group(P＜0.05). ③The ICU monitoring time of patients in JS-group was one-day less than that in PT-group, but there was no statistical significant difference between them(P＞0.05). Conclusion There had malnutrition and immune function decline in the patients with severe traumatic brain injury, in whom early enteral-nutrition bundle treatment can improve nutritional status and enhance the humoral immune function.