摘要
目的 分析重症脑卒中患者益生菌联合早期肠内营养治疗前后营养指标、炎症因子水平变化及预后危险因素.方法 回顾性选取自2020年1月至2022年10月邢台市第三医院收治的104例重症脑卒中患者作为研究对象,按照治疗方法不同将其分为对照组和观察组,各52例.两组均在常规治疗的基础上,对照组予以早期肠内营养治疗,观察组予以益生菌联合早期肠内营养治疗,持续治疗14 d.比较两组治疗后1 d的营养指标(总蛋白、前清蛋白、血红蛋白、甘油三酯)、炎症因子[超敏C-反应蛋白(hs-CRP)、降钙素原、白细胞计数(WBC)]、美国国立卫生研究院卒中量表(NIHSS)评分、急性生理学及慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、格拉斯哥昏迷指数(GCS)评分,以改良Rankin量表评分评价预后,使用单因素分析及多因素Logistic回归分析重症脑卒中患者预后的危险因素.结果 观察组治疗后1 d的总蛋白、前清蛋白、血红蛋白、甘油三酯水平分别为(67.83±5.60)g/L、(224.15±26.75)mg/L、(144.13± 8.77)g/L、(1.64±0.52)mmol/L,均高于对照组[(61.37±4.56)g/L、(172.56±18.73)mg/L、(130.68±6.74)g/L、(1.42±0.36)mmol/L],差异均有统计学意义(P＜0.05).观察组治疗后1 d的hs-CRP、降钙素原、WBC水平分别为(17.04±4.14)mg/L、(3.06±0.57)ng/L、(10.08±2.12)×109/L,均低于对照组[(26.14±5.62)mg/L、(5.17±1.28)ng/L、(13.30±2.87)× 109/L],差异均有统计学意义(P＜0.05).观察组治疗后1 d NIHSS评分、APACHE Ⅱ评分分别为(7.68±1.43)、(9.76±2.31)分,均低于对照组[(10.45±1.72)、(13.16±2.85)分],GCS 评分为(13.48±0.52)分,高于对照组[(12.26±0.48)分],差异均有统计学意义(P＜0.05).经单因素分析及多因素Logistic回归分析,高龄、NIHSS评分高、营养不良及APACHE Ⅱ评分高均是重症脑卒中患者预后的危险因素(P＜0.05).结论 益生菌联合早期肠内营养治疗能够有效改善重症脑卒中患者的营养状态,降低炎症反应水平,提高疗效,而患者的预后与年龄、病情轻重和营养状态有关,值得临床予以重视.
Abstract
Objective To analyze the changes of nutritional indexes,inflammatory factors and prognostic risk factors before and after pro-biotics combined with early enteral nutrition in patients with severe stroke.Methods This study was a retrospective analysis,104 cases of severe stroke patients admitted to Xingtai Third Hospital from January 2020 to October 2022 were selected and divided into the control group and the ob-servation group according to different treatment methods,with 52 cases in each group.Both groups were treated on the basis of conventional treat-ment,the control group was treated with early enteral nutrition,and the observation group was treated with probiotics combined with early enteral nutrition for 14 d.Nutritional indexes(total protein,pre-serum protein,hemoglobin,and triglycerides),inflammatory factors[hypersensitive C-reactive protein(hs-CRP),procalcitoninogen,white blood cell count(WBC)],National institutes of health stroke scale(NIHSS)score,a-cute physiology and chronic health status scoring system Ⅱ(APACHE Ⅱ)score,Glasgow coma score(GCS)score at 1 d after treatment were compared between two groups,and prognosis was evaluated by modified Rankin scale score,and risk for prognosis of patients with severe stroke was analyzed using univariate analysis and multifactor Logistic regression factors.Results The levels of total protein,pre-serum protein,hemo-globin,and triglyceride in the observation group at 1 d after treatment were(67.83±5.60)g/L,(224.15±26.75)mg/L,(144.13±8.77)g/L,and(1.64±0.52)mmol/L,respectively,which were higher than those in the control group[(61.37±4.56)g/L,(172.56±18.73)mg/L,(130.68±6.74)g/L,(1.42±0.36)mmol/L],the differences were statistically significant(P＜0.05).The levels of hs-CRP,pro-calcitonin,and WBC in the observation group at 1 d after treatment were(17.04±4.14)mg/L,(3.06±0.57)ng/L,and(10.08±2.12)× 109/L,respectively,which were lower than those in the control group[(26.14±5.62)mg/L,(5.17±1.28)ng/L,and(13.30±2.87)× 109/L],the differences were statistically significant(P＜0.05).The NIHSS scores,and APACHE Ⅱ scores of the observation group at 1 d af-ter treatment were(7.68±1.43)and(9.76±2.31)points,respectively,which were lower than those of the control group[(10.45±1.72)and(13.16±2.85)points],and the GCS score was(13.48±0.52)points,which was higher than those of the control group[(12.26±0.48)points],the differences were statistically significant(P＜0.05).After univariate analysis and multifactorial Logistic regression analysis,advanced age,high NIHSS score,malnutrition,and high APACHE Ⅱ score were all risk factors for the prognosis of severe stroke patients(P＜0.05).Conclusion Probiotics combined with early enteral nutrition can effectively improve the nutritional status of patients with severe stroke,reduce the level of inflammatory response,and improve the therapeutic effect.The prognosis of patients is related to age,severity of disease and nutritional status,which deserves clinical attention.
维普
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