| ObjectiveBy studying the use of a new fat-improving enteral nutrition supplemented with immunomodulators in patients with severe neurological disorder,the immune function and clinical outcomes of patients with severe neurological disease was explored.MethodThe patients with neurological disease who had complete clinical data admitted to the surgical intensive medicine department of the First Affiliated Hospital of Zhengzhou University from February to December in 2017 were divided into experimental group(fat modified enteral nutrition group)and control group(standard enteral nutrition group)according to the random number method.Enteral nutrition was started 24-48 hours after entering the ICU,and the required calorie was calculated according to the standard body mass[ideal body mass(kg)=height(cm)-105],and enteral nutrition was obtained through a nasogastric tube.The enteral nutrition dose and rate were adjusted according to the gastrointestinal tolerance score.Records:(1)General clinical data and acute physiology and chronic health status scoring system II(APACHE II)scores;(2)Enteral nutrition process:enteral nutrition time(d),feeding intolerance,drug usage;(3)The process of consciousness changes in patients:record the state of consciousness of patients admitted to hospital and discharged from hospital;GSC scores(GCS)on admission,discharge,and change of consciousness(d);(4)Outcome of clinical outcomes:mechanical ventilation time(d),ICU time(d),length of stay(d),follow-up of patients after discharge,Glasgow Outcome Scale(GOS)after 3 months of onset.(5)Blood routine,liver function,C-reactive protein(CRP),procalcitonin(PCT),and blood glucose were detected in the day(D0),day 6(D6),and discharge(D end)of the ICU.D6 lymphocyte subsets(percent CD4~+lymphocytes,CD8~+T lymphocytes,CD4~+/CD8~+ratio);inflammatory cytokines[tumor necrosis factor(TNF)-?,interleukin(IL)-6,IL-8,IL-10]expression level.ResultsThere were 57 patients with severe neurological disease that eventually met the inclusion criteria of this study.Among them,there were 27 cases in the experimental group and 30 cases in the control group.The age ranged from 18 to 77 years and the average age was(50.61±14.67)years.(1)There was no significant difference in gender,age,weight,heigtht,body mass index,admission diagnosis,comorbidity,surgery and APACHE II score between the two groups(all P>0.05).(2)Enteral nutrition process:There was no significant difference in enteral nutrition time and drug usage(P>0.05),but the incidence of feeding intolerance in the experimental group was low(4/27 vs.12/30,P=0.04).(3)Conscious state:consciousness at admission and discharge;GCS score at admission and discharge;days of consciousness improvement were no significant difference(P>0.05);and GCS difference(discharge-admittance)was statistically significant,experimental group vs.control group(5.89±3.82 vs.3.90±3.33,P=0.04).(4)Clinical outcomes:There was no statistical difference in mechanical ventilation time,ICU stay,hospitalization days and GOS score after 3 months of onset(all P>0.05).(5)There was no significant difference in blood glucose,liver function,blood routine,CRP and PCT between the experimental group and the control group:DO,D6,and D end(all P>0.05).(D0-D6)WBC count difference(10~9/L)[(1.42±6.18)vs.(-1.99±4.31),P=0.02],(D0-D6)neutrophil count difference(10~9/L)[(1.77±6.35)vs.(-1.31±4.30),P=0.03],percentage of CD4~+lymphocytes on D6 day[(26.76±2.24)vs.(20.36±2.00),P=0.04];percentage of CD8~+T lymphocytes[(15.66±1.35)vs.(15.23±1.35),P>0.05],CD4~+/CD8~+[(1.94±0.20)vs.(1.32±0.12),P=0.01],Inflammatory factor(pg/ml)IL-6[(9.22±2.06)vs.(18.08±3.74),P=0.04],IL-8[(74.81±7.32)vs.(101.12±6.00),P=0.01],IL-10[(72.22±5.03)vs.(107.71±12.89),P=0.01],TNF-?[(70.88±3.50)vs.(96.22±9.50),P=0.02].ConclusionThe addition of immunomodulatory in fat modified enteral nutrition is safe and well tolerated.It can improve the GCS score,enhance immune function,and reduce the release of inflammatory cytokines in patients with severe neurological disease. |
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