目的 本研究旨在探讨重症颅脑损伤患者在肠内营养(EN)和肠外营养(PN)支持下，静息能量消耗(REE)的变化，并研究口腔菌群的变化及其与患者预后的相关性。方法 本研究选取2023年1月至2024年3月在河北省沧州市中心医院入ICU时间48号内的重症颅脑损伤患者100例，随机分为肠内营养组(EN组，n=50)和肠外营养组(PN组，n=50)。通过间接量热法在人ICU后24 h内、72 h、7 d和14 d测量患者的REE，同时在相同时间点采集口腔菌群样本，使用16S rRNA基因测序技术分析菌群多样性和结构。预后评估包括ICU住院时间、总住院时间及格拉斯哥预后评分(GOS)。结果 EN 组和 PN 组在入 ICU 后 24 h 内、72 h、7 d 和 1 4d 的 REE 分别为(1850。32±210。45)kcal/day、(1802。18±195。67)kcal/day(P=0。235)，(1920。45±220。34)kcal/day、(1885。47±210。12)kcal/day(P=0。429)，(1955。67±230。56)kcal/day、(1902。58±220。34)kcal/day(P=0。224)，(1998。34±240。67)kcal/day、(1940。45±230。12)kcal/day(P=0。204)，两组间差异均无统计学意义。EN组和PN组在各时间点的Shannon指数均呈现增加趋势，但差异无统计学意义。ICU住院时间和总住院时间在EN组和PN组之间无差异，分别为(14。32±4。56)d、(13。89±4。34)d(P=0。538)和(30。45±7。89)d、(29。98±7。56)d(P=0。449)。GOS评分的分布在两组之间差异无统计学意义(x2=0。566，P=0。904)。REE与Shannon指数在人ICU后24 h内、72 h和7 d显示出显著的正相关性，相关系数分别为 0。215(P=0。032)，0。198(P=0。046)和 0。223(P=0。027);入 ICU 后 14 d 的相关系数为 0。189(P=0。055)，未达到统计学显著性。Shannon指数与ICU住院时间、总住院时间以及GOS评分之间的相关性均未达到统计学显著性(P＞0。05)。结论 重症颅脑损伤患者在肠内营养和肠外营养支持下的静息能量消耗和口腔菌群变化趋势相似，2种营养支持方式对REE和口腔菌群的影响无显著差异。尽管REE与口腔菌群多样性在早期阶段存在显著的正相关性，但口腔菌群多样性与患者预后之间未观察到显著相关性。
Changes and prognostic relevance of oral flora in patients with severe craniocerebral injury supported by resting energy depletion enteral and parenteral nutrition
Objective To investigate the changes in resting energy expenditure(REE)in patients with severe craniocerebral injury under enteral nutrition(EN)and parenteral nutrition(PN)support,and to study the changes in oral flora and their correlation with patient prognosis.Methods A total of 100 patients with severe craniocerebral injury who were admitted to the ICU within 48 days in Cangzhou Central Hospital,Hebei Province from January 2023 to March 2024 were randomly divided into enteral nutrition group(EN group,n=50)and parenteral nutrition group(PN group,n=50).The patients'REE was measured by indirect calorimetry within 24 h,72 h,7 d,and 14 d after admission to the ICU.Oral flora samples were collected at the same time points,and the diversity and structure of the flora were analyzed using 16S rRNA gene sequencing technology.Prognostic evaluation included ICU length of stay,total length of stay,and Glasgow Outcome Score(GOS).Results The REE in the EN group and the PN group within 24 h,72 h,7 d,and 14 d after admission to the ICU were(1850.32±210.45)kcal/day and(1802.18±195.67)kcal/day(P=0.235),(1920.45±220.34)kcal/day and(1885.47±210.12)kcal/day(P=0.429),(1955.67±230.56)kcal/day and(1902.58±220.34)kcal/day(P=0.224),(1998.34±240.67)kcal/day and(1940.45±230.12)kcal/day(P=0.204),respectively.There was no significant difference between the two groups.The Shannon index of the EN group and the PN group showed an increasing trend at each time point,but the difference was not statistically significant.There was no difference in ICU stay and total hospital stay between the EN group and the PN group,which were(14.32±4.56)d,(13.89±4.34)d(P=0.538)and(30.45±7.89)d,(29.98±7.56)d(P=0.449),respectively.There was no statistically significant difference in the distribution of GOS scores between the two groups(x2=0.566,P=0.904).REE and Shannon index showed significant positive correlation within 24 h,72 h and 7 d after ICU admission,with correlation coefficients of 0.215(P=0.032),0.198(P=0.046)and 0.223(P=0.027),respectively;the correlation coefficient was 0.189(P=0.055)14 d after ICU admission,which did not reach statistical significance.The correlation between Shannon index and ICU length of stay,total length of stay and GOS score did not reach statistical significance(P＞0.05).Conclusion The trends of resting energy expenditure and oral flora changes in patients with severe craniocerebral injury under enteral nutrition and parenteral nutrition support are similar,and there is no significant difference in the effects of the two nutritional support methods on REE and oral flora.Although there is a significant positive correlation between REE and oral flora diversity in the early stage,no significant correlation was observed between oral flora diversity and patient prognosis.
severe craniocerebral injuryresting energy expenditureenteral nutritionparenteral nutritionoral flora
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