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目的探讨双歧三联活菌肠溶胶囊联合早期肠内营养支持在大面积脑梗死中的应用。方法选取住院治疗大面积脑梗死患者96例,随机分为观察组和对照组各48例。两组患者予以控制颅内压、血压及血糖、抗血小板聚集、改善微循环及营养和保护脑细胞等基础治疗。对照组患者行肠内营养支持治疗,予以肠内营养液输注泵持续恒速缓慢输注,先500mL/d后逐渐增至1 500~2 000mL/d。观察组患者在对照组基础上加用双歧三联活菌肠溶胶囊630mg研磨水化后自鼻饲注入,3次/d,连用4周。观察两组患者治疗前和治疗4周后营养状况指标、GCS评分、粪便分泌型IgA(sIgA)和胃肠功能的变化,并评估其临床疗效。结果治疗4周后,两组患者血清总蛋白(TP)和白蛋白(ALB)指标明显下降(t=2.26、2.37、2.92、3.07,P<0.05或P<0.01),且观察组下降幅度低于对照组(t=2.23、2.21,P<0.05);两组患者GCS评分明显上升(t=2.39、3.27,P<0.05或P<0.01),且观察组上升幅度更明显(t=2.19,P<0.05);两组患者粪便sIgA水平明显上升(t=2.35、3.14,P<0.05或P<0.01),且观察组上升幅度更明显(t=2.18,P<0.05);治疗期间,观察组治疗时胃肠功能情况优于对照组(χ2=5.44,P<0.05);治疗4周后,在总有效率上观察组优于对照组(χ2=4.38,P<0.05)。结论双歧三联活菌肠溶胶囊联合早期肠内营养支持用于大面积脑梗死临床疗效较确切,促进神经功能康复,推测其可能通过提高患者粪便sIgA水平,改善其胃肠功能,从而减缓其营养状况恶化,提高GCS评分,改善其预后。
Objective To investigate the application of live bifidobacterium enteric-coated enteric-coated capsules combined with early enteral nutrition support in large area cerebral infarction. Methods Ninety-six patients with large-area cerebral infarction were selected and randomly divided into observation group and control group with 48 cases each. Two groups of patients to be controlled intracranial pressure, blood pressure and blood glucose, anti-platelet aggregation, improve microcirculation and nutrition and protection of brain cells and other basic treatment. Patients in the control group underwent enteral nutrition support. The infusion pump of enteral nutrition solution was continuously infused slowly and steadily at the first 500 mL / d and then gradually increased to 1 500-2 000 mL / d. Observation group patients in the control group based on the use of bifidobacterium triple enteric-coated enteric-coated capsules 630mg after hydration from nasal injection, 3 times / d, once every 4 weeks. The nutritional status, GCS score, excretion-type IgA (sIgA) and gastrointestinal function of the two groups were observed before treatment and after 4 weeks of treatment, and the clinical efficacy was evaluated. Results After 4 weeks of treatment, the levels of serum total protein (TP) and albumin (ALB) in two groups were significantly decreased (t = 2.26,2.37,2.92,3.07, P <0.05 or P <0.01) (T = 2.23,2.21, P <0.05). GCS score of two groups increased significantly (t = 2.39, 3.27, P <0.05 or P <0.01) (T = 2.18, P <0.05). The levels of sIgA in feces of two groups were significantly increased (t = 2.35,3.14, P <0.05 or P <0.01) The gastrointestinal function was better in the treatment group than in the control group (χ2 = 5.44, P <0.05). After 4 weeks of treatment, the total effective rate was better in the observation group than in the control group (χ2 = 4.38, P <0.05). Conclusions Bifid triple viable enteric-coated enteric-coated capsules combined with early enteral nutrition support for the treatment of large-area cerebral infarction is more effective and neurological rehabilitation is presumed. It is presumed that it may improve the gastrointestinal function of sIgA in feces of patients and slow down its gastrointestinal function Nutritional deterioration worsens, improves GCS score, and improves prognosis.