Immune Indicators In Patients With Acute Brain Injury And The Influence Of Early Enteral Nutrition On Immune Indexes

Objective To study immune and inflammatory index change and clinical significance of different severity in patients with acute craniocerebral injury, and evaluation of early enteral nutrition influence on the immune function of patients with severe craniocerebral trauma, enhance resistance, reduce the infection rate,improve the prognosis.Methods 80 cases of patients with acute craniocerebral trauma who were admitted to ICU jiangsu wujin people’s Hospital affiliated to Jiangsu University from April 2013 to March 2015 were divided into three groups, according to the Glasgow scale(GCS), light group(20 cases), medium(20 cases), heavy group(40 cases), Monitor the lymphocyte ratio,CD4,CD8 and CD4/CD8, HLADR, PCT,CRP changes,observing 24 hours APACHEⅡ scores, ICU indwelling time, serious complications and prognosis, and 40 patients in heavy group were randomly divided into enteral nutrition group(group A, n = 20, admitted to hospital 24 hours start nasogastric) and control group(group B, n=20, parenteral nutrition, nasogastric after 96 hours).Compare two groups of patients with immune function change.Results(1) the more deep coma APACHEⅡscore is higher(P < 0.05); on first day,the lymphocyte ratio and CD4 have no statistical difference;on the third day,seventh day and fourteenth day,there were statistically significant between different groups of the lymphocyte ratio,the more light coma, the more immune index faster recovery; on the first day, CD8 in heavy group increased significantly compared with other two groups(P<0.05), on the seventh day, CD8 in light roup, compared with other two group increased significantly(P<0.05);on the first day and seventh day HLADR in heavy group compared with other two groups was obviously decreased(P<0.05),no difference between the light and medium groups;PCT and CRP in heavy group, compared with other two groups have significant difference(P <0.05);The infection rate in Heavy group is higher than the light group(P<0.05),no difference between the other groups;The more deep coma, ICU lien the longer(P<0.05), the more cost;28 days, 90 days survival rate has no difference.(2) The early enteral nutrition group had no statistical difference compared with control group in age, APACHE Ⅱ score and the initial immune indexes, but treatment to seventh day, the lymphocyte ratio, CD4 and HLADR improved significantly in early enteral nutrition group(P<0.05), at the same time CD8, PCT and CRP were significantly decreased(P<0.05), the i CU retention time was shorter(P<0.05).Conclusion The heavier damage, the worse immune function of patients with acute craniocerebral trauma; the early enteral nutrition treatment can effectively enhance the immune function,reduce inflammation, lower the incidence of infection, improve the prognosis.