联合益生菌的早期肠内营养对高血压脑出血患者营养状况的影响

发布时间：2018-05-24 01:20

本文选题：高血压脑出血 + 肠内营养　；参考：《泸州医学院》2014年硕士论文

【摘要】：目的：高血压脑出血患者的机体常出现严重的代谢紊乱，自主神经的调节功能紊乱及神经传导异常等，表现为高分解、高代谢状态；同时，免疫功能受到严重抑制，易导致机体发生严重感染、甚至多器官功能衰竭。由此影响正常的胃肠功能，难以保障有效的肠内营养，机体呈现为负氮平衡，进一步抑制机体的免疫功能，导致病死率及病残率增加。因此，恢复高血压脑出血患者正常的胃肠道功能，纠正失衡的营养状态，，提高患者的免疫功能对促进神经功能恢复显得尤其重要。肠内营养联合益生菌在结直肠恶性肿瘤围手术期的运用，能够有效防止肠道的菌群失调，促进肠道和肝功能的恢复，改善营养状况，提高机体免疫力，降低术后感染率。但是目前将益生菌应用于重症高血压脑出血患者的研究较少，还难以确定益生菌用于治疗高血压脑出血的重症患者能否发挥有利作用。本研究通过观察早期肠内营养中添加益生菌对高血压脑出血患者营养状况、免疫功能以及预后的影响，以期为高血压脑出血的综合治疗提供参考依据。方法：将泸州医学院附属自贡市第四人民医院2013年2月至2014年1月期间连续收治的50例高血压脑出血患者随机分为治疗组和对照组，两组患者年龄、性别构成、身体一般情况等方面比较无统计学差异(p0.05)。两组患者均在入院后48～72h开始进行早期肠内营养，治疗组在肠内营养基础上同时添加益生菌。分别选取肠内营养支持治疗开始第1，7，14，21天，监测血清总蛋白、白蛋白、血红蛋白和淋巴细胞计数、上臂围、上臂二头肌部位皮褶厚度等指标，观察住院期间患者是否发生消化道出血、肠道菌群失调以及肺部感染，并观察患者近期的意识恢复情况。结果：1.益生菌对营养状况指标的影响：两组患者的血清总蛋白、白蛋白、血红蛋白水平、淋巴细胞计数各时相点上比较均无统计学差异(p0.05)；在营养支持后第7天益生菌治疗组各项指标与对照组比较无统计学差异(p0.05)；第14天益生菌治疗组血清总蛋白、白蛋白、血红蛋白水平、淋巴细胞计数高于对照组，但无统计学差异(p0.05)；第21天益生菌治疗组血清总蛋白、白蛋白、血红蛋白水平、淋巴细胞计数均高于对照组，具有统计学差异(p0.05)。在营养支持后第7天益生菌治疗组上臂围及上臂二头肌部位皮褶厚度的变化程度与对照组比较无统计学差异(p0.05)，第14天、第21天益生菌治疗组上臂围及上臂二头肌部位皮褶厚度较营养支持开始时的下降程度均低于对照组，具有统计学差异(p0.05)。2.益生菌对消化道出血的影响：营养支持21天内益生菌治疗组发生消化道出血的例数明显少于对照组，有统计学差异(p0.05)，且对发生消化道出血患者的治疗时间上益生菌治疗组短于对照组(p0.05)。3.益生菌对肠道菌群的影响：营养支持21天内益生菌治疗组发生肠道菌群失调的例数明显少于对照组，有统计学差异(p0.05)，纠正肠道菌群失调所用时间上益生菌治疗组短于对照组(p0.05)。4.益生菌对肺部感染发生率的影响：营养支持21天内益生菌治疗组肺部感染发生率与对照组比较无统计学差异(p0.05)，但益生菌治疗组患者在抗生素使用时间上短于对照组，具有统计学差异(p0.05)。5.患者近期的意识恢复情况：营养支持21天益生菌治疗组患者意识好转的例数多于对照组，具有统计学差异(p0.05)；第60天治疗组患者意识好转的例数多于对照组，但无统计学差异(p0.05)。结论：早期添加益生菌的肠内营养可以改善高血压脑出血后的营养状况及肠道功能紊乱，降低患者的消化道出血发生率，提高患者营养状态以增强机体的免疫能力，从而提高患者抗感染的能力，缩短肺部感染的治疗时间。对患者意识的好转有一定促进作用，有利于患者后期神经功能的恢复。
[Abstract]:Objective: the patients with hypertensive intracerebral hemorrhage often have serious metabolic disorders, regulatory dysfunction of autonomic nerves and abnormal nerve conduction, which are characterized by high decomposition and high metabolic state. At the same time, the immune function is severely inhibited, which may lead to severe infection and most organ failure. Thus it affects the normal gastrointestinal work. It is difficult to guarantee the effective enteral nutrition. The body presents a negative nitrogen balance, further inhibits the immune function of the body, and leads to the increase of mortality and morbidity. Therefore, it is especially important to restore the normal gastrointestinal function of hypertensive cerebral hemorrhage patients, correct the unbalanced nutritional status and improve the immune function of the patients to promote the recovery of nerve function. The application of enteral nutrition combined with probiotics in the perioperative period of colorectal malignant tumor can effectively prevent the dysbacteria from intestinal flora, promote the recovery of intestinal and liver function, improve the nutritional status, improve the immunity of the body and reduce the postoperative infection rate. However, there are few studies on the application of probiotics to the patients with severe hypertensive intracerebral hemorrhage. To determine whether probiotics can play a beneficial role in the treatment of hypertensive intracerebral hemorrhage. This study provides a reference for the combined treatment of hypertensive intracerebral hemorrhage by observing the effects of probiotics on the nutritional status, immune function and prognosis of hypertensive intracerebral hemorrhage by adding probiotics to early enteral nutrition. 50 patients with hypertensive intracerebral hemorrhage in Zigong Fourth People's Hospital from February 2013 to January 2014 were randomly divided into the treatment group and the control group. There was no statistical difference between the two groups of patients with age, sex composition and general physical condition (P0.05). The two groups were in the early intestinal tract from 48 to 72h after admission. Nutrition, the treatment group added probiotics on the basis of enteral nutrition on the basis of enteral nutrition. Select the enteral nutrition support for the first 1,7,14,21 days, and monitor the serum total protein, albumin, hemoglobin and lymphocyte count, upper arm circumference, and the thickness of the skin fold of the two head of the upper arm, and observe the gastrointestinal bleeding and intestinal tract during the hospitalization. The effect of 1. probiotics on the nutritional status: the total serum protein, albumin, hemoglobin level and lymphocyte count of the two groups were not statistically different (P0.05), and the probiotics were treated at seventh days after nutritional support. There was no statistical difference between the control group and the control group (P0.05). The serum total protein, albumin, hemoglobin level and lymphocyte count of the probiotic treatment group were higher than those of the control group at fourteenth days, but there was no statistical difference (P0.05). The total protein, albumin, hemoglobin level and lymphocyte count of probiotic treatment group were higher than those of the control group at twenty-first days. There was a statistical difference (P0.05). There was no significant difference in the thickness of the skin fold of the upper arm circumference and the two head of the upper arm in the probiotic treatment group after seventh days of nutritional support (P0.05). On the fourteenth day, the thickness of the skin fold of the upper arm circumference and the upper arm two head in the twenty-first day probiotic treatment group was more than the descent of the nutritional support. The effect of P0.05.2. probiotics on digestive tract bleeding was significantly lower than that of the control group. The number of digestive tract bleeding in the probiotic treatment group was significantly less than that in the control group within 21 days, with a statistically significant difference (P0.05), and the probiotic treatment group was shorter than the control group (P0.05) for the treatment time of the patients with gastrointestinal bleeding. The effect of.3. probiotics on intestinal flora: the number of intestinal flora imbalance in the probiotic group in 21 days was significantly less than that in the control group, and the difference was statistically significant (P0.05). The effect of probiotic treatment group on the time of correcting intestinal dysbacteria was shorter than that of the control group (P0.05).4. beneficial bacteria on the incidence of pulmonary infection: nutritional support 21 There was no significant difference in the incidence of pulmonary infection between the probiotic treatment group and the control group (P0.05), but the probiotic treatment group was shorter than the control group in the time of antibiotic use, with a statistically significant difference (P0.05) the recent recovery of the consciousness of.5. patients: the number of patients in the 21 day probiotic treatment group was more than those in the control group. There were statistical differences (P0.05). The number of cases in the sixtieth day treatment group was more than that of the control group, but there was no statistical difference (P0.05). Conclusion: early addition of probiotic enteral nutrition can improve the nutritional status and intestinal dysfunction after hypertensive intracerebral hemorrhage, reduce the incidence of gastrointestinal bleeding, and improve the patient camp. In order to enhance the immune ability of the body, it can improve the patient's ability to resist infection and shorten the treatment time of the lung infection. It has a certain effect on the improvement of the consciousness of the patients, and is beneficial to the recovery of the later nerve function of the patient.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34

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