本文選題：高血壓腦出血 + 腸內(nèi)營(yíng)養(yǎng)��； 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：高血壓腦出血患者的機(jī)體常出現(xiàn)嚴(yán)重的代謝紊亂，自主神經(jīng)的調(diào)節(jié)功能紊亂及神經(jīng)傳導(dǎo)異常等，表現(xiàn)為高分解、高代謝狀態(tài)；同時(shí)，免疫功能受到嚴(yán)重抑制，易導(dǎo)致機(jī)體發(fā)生嚴(yán)重感染、甚至多器官功能衰竭。由此影響正常的胃腸功能，難以保障有效的腸內(nèi)營(yíng)養(yǎng)，機(jī)體呈現(xiàn)為負(fù)氮平衡，進(jìn)一步抑制機(jī)體的免疫功能，導(dǎo)致病死率及病殘率增加。因此，恢復(fù)高血壓腦出血患者正常的胃腸道功能，糾正失衡的營(yíng)養(yǎng)狀態(tài)，，提高患者的免疫功能對(duì)促進(jìn)神經(jīng)功能恢復(fù)顯得尤其重要。腸內(nèi)營(yíng)養(yǎng)聯(lián)合益生菌在結(jié)直腸惡性腫瘤圍手術(shù)期的運(yùn)用，能夠有效防止腸道的菌群失調(diào)，促進(jìn)腸道和肝功能的恢復(fù)，改善營(yíng)養(yǎng)狀況，提高機(jī)體免疫力，降低術(shù)后感染率。但是目前將益生菌應(yīng)用于重癥高血壓腦出血患者的研究較少，還難以確定益生菌用于治療高血壓腦出血的重癥患者能否發(fā)揮有利作用。本研究通過(guò)觀察早期腸內(nèi)營(yíng)養(yǎng)中添加益生菌對(duì)高血壓腦出血患者營(yíng)養(yǎng)狀況、免疫功能以及預(yù)后的影響，以期為高血壓腦出血的綜合治療提供參考依據(jù)。方法：將瀘州醫(yī)學(xué)院附屬自貢市第四人民醫(yī)院2013年2月至2014年1月期間連續(xù)收治的50例高血壓腦出血患者隨機(jī)分為治療組和對(duì)照組，兩組患者年齡、性別構(gòu)成、身體一般情況等方面比較無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。兩組患者均在入院后48～72h開始進(jìn)行早期腸內(nèi)營(yíng)養(yǎng)，治療組在腸內(nèi)營(yíng)養(yǎng)基礎(chǔ)上同時(shí)添加益生菌。分別選取腸內(nèi)營(yíng)養(yǎng)支持治療開始第1，7，14，21天，監(jiān)測(cè)血清總蛋白、白蛋白、血紅蛋白和淋巴細(xì)胞計(jì)數(shù)、上臂圍、上臂二頭肌部位皮褶厚度等指標(biāo)，觀察住院期間患者是否發(fā)生消化道出血、腸道菌群失調(diào)以及肺部感染，并觀察患者近期的意識(shí)恢復(fù)情況。結(jié)果：1.益生菌對(duì)營(yíng)養(yǎng)狀況指標(biāo)的影響：兩組患者的血清總蛋白、白蛋白、血紅蛋白水平、淋巴細(xì)胞計(jì)數(shù)各時(shí)相點(diǎn)上比較均無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)；在營(yíng)養(yǎng)支持后第7天益生菌治療組各項(xiàng)指標(biāo)與對(duì)照組比較無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)；第14天益生菌治療組血清總蛋白、白蛋白、血紅蛋白水平、淋巴細(xì)胞計(jì)數(shù)高于對(duì)照組，但無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)；第21天益生菌治療組血清總蛋白、白蛋白、血紅蛋白水平、淋巴細(xì)胞計(jì)數(shù)均高于對(duì)照組，具有統(tǒng)計(jì)學(xué)差異(p0.05)。在營(yíng)養(yǎng)支持后第7天益生菌治療組上臂圍及上臂二頭肌部位皮褶厚度的變化程度與對(duì)照組比較無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)，第14天、第21天益生菌治療組上臂圍及上臂二頭肌部位皮褶厚度較營(yíng)養(yǎng)支持開始時(shí)的下降程度均低于對(duì)照組，具有統(tǒng)計(jì)學(xué)差異(p0.05)。2.益生菌對(duì)消化道出血的影響：營(yíng)養(yǎng)支持21天內(nèi)益生菌治療組發(fā)生消化道出血的例數(shù)明顯少于對(duì)照組，有統(tǒng)計(jì)學(xué)差異(p0.05)，且對(duì)發(fā)生消化道出血患者的治療時(shí)間上益生菌治療組短于對(duì)照組(p0.05)。3.益生菌對(duì)腸道菌群的影響：營(yíng)養(yǎng)支持21天內(nèi)益生菌治療組發(fā)生腸道菌群失調(diào)的例數(shù)明顯少于對(duì)照組，有統(tǒng)計(jì)學(xué)差異(p0.05)，糾正腸道菌群失調(diào)所用時(shí)間上益生菌治療組短于對(duì)照組(p0.05)。4.益生菌對(duì)肺部感染發(fā)生率的影響：營(yíng)養(yǎng)支持21天內(nèi)益生菌治療組肺部感染發(fā)生率與對(duì)照組比較無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)，但益生菌治療組患者在抗生素使用時(shí)間上短于對(duì)照組，具有統(tǒng)計(jì)學(xué)差異(p0.05)。5.患者近期的意識(shí)恢復(fù)情況：營(yíng)養(yǎng)支持21天益生菌治療組患者意識(shí)好轉(zhuǎn)的例數(shù)多于對(duì)照組，具有統(tǒng)計(jì)學(xué)差異(p0.05)；第60天治療組患者意識(shí)好轉(zhuǎn)的例數(shù)多于對(duì)照組，但無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。結(jié)論：早期添加益生菌的腸內(nèi)營(yíng)養(yǎng)可以改善高血壓腦出血后的營(yíng)養(yǎng)狀況及腸道功能紊亂，降低患者的消化道出血發(fā)生率，提高患者營(yíng)養(yǎng)狀態(tài)以增強(qiáng)機(jī)體的免疫能力，從而提高患者抗感染的能力，縮短肺部感染的治療時(shí)間。對(duì)患者意識(shí)的好轉(zhuǎn)有一定促進(jìn)作用，有利于患者后期神經(jīng)功能的恢復(fù)。
[Abstract]:Objective: the patients with hypertensive intracerebral hemorrhage often have serious metabolic disorders, regulatory dysfunction of autonomic nerves and abnormal nerve conduction, which are characterized by high decomposition and high metabolic state. At the same time, the immune function is severely inhibited, which may lead to severe infection and most organ failure. Thus it affects the normal gastrointestinal work. It is difficult to guarantee the effective enteral nutrition. The body presents a negative nitrogen balance, further inhibits the immune function of the body, and leads to the increase of mortality and morbidity. Therefore, it is especially important to restore the normal gastrointestinal function of hypertensive cerebral hemorrhage patients, correct the unbalanced nutritional status and improve the immune function of the patients to promote the recovery of nerve function. The application of enteral nutrition combined with probiotics in the perioperative period of colorectal malignant tumor can effectively prevent the dysbacteria from intestinal flora, promote the recovery of intestinal and liver function, improve the nutritional status, improve the immunity of the body and reduce the postoperative infection rate. However, there are few studies on the application of probiotics to the patients with severe hypertensive intracerebral hemorrhage. To determine whether probiotics can play a beneficial role in the treatment of hypertensive intracerebral hemorrhage. This study provides a reference for the combined treatment of hypertensive intracerebral hemorrhage by observing the effects of probiotics on the nutritional status, immune function and prognosis of hypertensive intracerebral hemorrhage by adding probiotics to early enteral nutrition. 50 patients with hypertensive intracerebral hemorrhage in Zigong Fourth People's Hospital from February 2013 to January 2014 were randomly divided into the treatment group and the control group. There was no statistical difference between the two groups of patients with age, sex composition and general physical condition (P0.05). The two groups were in the early intestinal tract from 48 to 72h after admission. Nutrition, the treatment group added probiotics on the basis of enteral nutrition on the basis of enteral nutrition. Select the enteral nutrition support for the first 1,7,14,21 days, and monitor the serum total protein, albumin, hemoglobin and lymphocyte count, upper arm circumference, and the thickness of the skin fold of the two head of the upper arm, and observe the gastrointestinal bleeding and intestinal tract during the hospitalization. The effect of 1. probiotics on the nutritional status: the total serum protein, albumin, hemoglobin level and lymphocyte count of the two groups were not statistically different (P0.05), and the probiotics were treated at seventh days after nutritional support. There was no statistical difference between the control group and the control group (P0.05). The serum total protein, albumin, hemoglobin level and lymphocyte count of the probiotic treatment group were higher than those of the control group at fourteenth days, but there was no statistical difference (P0.05). The total protein, albumin, hemoglobin level and lymphocyte count of probiotic treatment group were higher than those of the control group at twenty-first days. There was a statistical difference (P0.05). There was no significant difference in the thickness of the skin fold of the upper arm circumference and the two head of the upper arm in the probiotic treatment group after seventh days of nutritional support (P0.05). On the fourteenth day, the thickness of the skin fold of the upper arm circumference and the upper arm two head in the twenty-first day probiotic treatment group was more than the descent of the nutritional support. The effect of P0.05.2. probiotics on digestive tract bleeding was significantly lower than that of the control group. The number of digestive tract bleeding in the probiotic treatment group was significantly less than that in the control group within 21 days, with a statistically significant difference (P0.05), and the probiotic treatment group was shorter than the control group (P0.05) for the treatment time of the patients with gastrointestinal bleeding. The effect of.3. probiotics on intestinal flora: the number of intestinal flora imbalance in the probiotic group in 21 days was significantly less than that in the control group, and the difference was statistically significant (P0.05). The effect of probiotic treatment group on the time of correcting intestinal dysbacteria was shorter than that of the control group (P0.05).4. beneficial bacteria on the incidence of pulmonary infection: nutritional support 21 There was no significant difference in the incidence of pulmonary infection between the probiotic treatment group and the control group (P0.05), but the probiotic treatment group was shorter than the control group in the time of antibiotic use, with a statistically significant difference (P0.05) the recent recovery of the consciousness of.5. patients: the number of patients in the 21 day probiotic treatment group was more than those in the control group. There were statistical differences (P0.05). The number of cases in the sixtieth day treatment group was more than that of the control group, but there was no statistical difference (P0.05). Conclusion: early addition of probiotic enteral nutrition can improve the nutritional status and intestinal dysfunction after hypertensive intracerebral hemorrhage, reduce the incidence of gastrointestinal bleeding, and improve the patient camp. In order to enhance the immune ability of the body, it can improve the patient's ability to resist infection and shorten the treatment time of the lung infection. It has a certain effect on the improvement of the consciousness of the patients, and is beneficial to the recovery of the later nerve function of the patient.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.34

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李鳴;杭春華;史繼新;陳罡;;谷氨酰胺對(duì)創(chuàng)傷性腦損傷后腸黏膜超微結(jié)構(gòu)和細(xì)胞凋亡的影響[J];腸外與腸內(nèi)營(yíng)養(yǎng);2008年01期

2 林玲萍;張智敏;鄭培奮;金福碧;杜麗云;;老年重癥急性胰腺炎早期腸內(nèi)營(yíng)養(yǎng)支持被動(dòng)中止因素分析和護(hù)理[J];腸外與腸內(nèi)營(yíng)養(yǎng);2010年02期

3 王廬荊;賀德;胡翔;顧元博;鄧明武;;生態(tài)免疫營(yíng)養(yǎng)對(duì)缺血再灌注的肝硬化大鼠肝臟保護(hù)的作用[J];廣東醫(yī)學(xué);2013年03期

4 卓銀霞;熱依娜;李萍;;腫瘤患者營(yíng)養(yǎng)不良的研究進(jìn)展[J];護(hù)理管理雜志;2010年10期

5 秦德廣;楊靈;;生態(tài)營(yíng)養(yǎng)在高血壓腦出血術(shù)后的應(yīng)用[J];中國(guó)實(shí)用神經(jīng)疾病雜志;2011年07期

6 錢昆,鄭亞明,趙紫罡,伍曉汀;腸道微生態(tài)制劑的臨床應(yīng)用及進(jìn)展[J];華西醫(yī)學(xué);2005年02期

7 羅秋云;羅偉良;邱金華;;早期腸內(nèi)營(yíng)養(yǎng)對(duì)高血壓腦出血并發(fā)應(yīng)激性潰瘍上消化道出血預(yù)防作用的研究[J];黑龍江醫(yī)藥科學(xué);2006年05期

8 馮肖亞;崔元孝;劉敬花;;血清膠質(zhì)纖維酸性蛋白和高血壓性腦出血的相關(guān)性[J];臨床神經(jīng)病學(xué)雜志;2008年03期

9 趙鴻;錢忠心;劉衛(wèi)東;毛青;葉樹銘;龔良;劉向陽(yáng);丁勇;彭毅華;孫偉;;神經(jīng)導(dǎo)航定向內(nèi)窺鏡下微創(chuàng)治療高血壓腦出血[J];臨床神經(jīng)外科雜志;2008年02期

10 許強(qiáng)宏;戴海文;陳進(jìn);嚴(yán)靜;龔仕金;;加用早期微生態(tài)制劑的腸內(nèi)營(yíng)養(yǎng)在高血壓腦出血術(shù)后的應(yīng)用[J];臨床外科雜志;2008年05期

本文編號(hào)：1927139