内科

目的探讨早期康复锻炼联合免疫肠内营养支持对老年重症脑卒中患者神经功能恢复的影响。方法选取2017年3月至2019年5月我院收治的老年重症脑卒中患者98例，随机分为对照组和观察组，每组49例。两组患者均给予脑卒中常规综合治疗以及早期康复锻炼。在此基础上，观察组患者给予肠内营养乳剂（TPF-T）进行免疫肠内营养支持治疗，对照组患者则给予肠内营养混悬液进行常规肠内营养支持治疗。比较两组患者治疗前、治疗第10天、治疗第21天的血清白蛋白（ALB）、血红蛋白（Hb）、甘油三酯（TG）、肿瘤坏死因子-α（TNF-α）、白细胞介素-2（IL-2）、白细胞介素-6（IL-6）水平；比较两组患者治疗前后的改良Barthel（BI）量表和美国国立卫生研究院卒中量表（NIHSS）评分；比较两组患者治疗期间的不良反应发生情况。结果两组患者的血清ALB、Hb和TG水平均随着干预时间的变化而变化,观察组患者的血清ALB、Hb和TG水平先下降后上升，对照组患者的血清ALB、Hb和TG水平呈逐渐下降趋势；早期康复锻炼、肠内营养支持干预与干预时间之间存在交互效应（P＜0.05）。两组患者的血清TNF-α、IL-2、IL-6水平均着随干预时间的延长而逐渐下降；早期康复锻炼、肠内营养支持干预与干预时间之间存在交互效应（P＜0.05）。出院8周后，两组患者的BI评分均显著增高，NIHSS评分均显著降低；观察组患者的BI评分显著高于对照组，NIHSS评分显著低于对照组，差异有统计学意义（P＜0.05）。治疗过程中两组患者的不良反应发生率比较差异无统计学意义（P＞0.05）。结论早期康复锻炼联合免疫肠内营养支持能有效改善老年重症脑卒中患者的营养状况，减轻炎症反应，促进神经功能恢复，值得推广应用。

ObjectiveTo investigate the effects of early rehabilitation exercise combined with immune enteral nutrition on the recovery of neurological function of elderly patients with severe stroke. MethodsA total of 98 elderly patients with severe stroke admitted to our hospital from March 2017 to May 2019 were selected, and they were randomly divided into control group and observation group, with 49 cases in each group. Both patients were given routine comprehensive treatment of stroke and early rehabilitation exercise, based on which the patients in the observation group were given enteral nutrition emulsion (TPF-T) for immune enteral nutrition treatment, whereas the patients in the control group were given enteral nutrition suspension for routine enteral nutrition treatment. The levels of serum albumin (ALB), triglyceride (TG), hemoglobin (Hb), tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2) and interleukin-6 (IL-6) before treatment, on the 10th and 21st days after treatment were compared between the two groups. The pre- and post-intervention scores of modified Barthel Index (BI) scale and the National Institute Health Stroke Scale (NIHSS) were compared between the two groups. The adverse reactions during the treatment were also compared between the two groups. ResultsThe levels of serum ALB, Hb and TG changed with the intervention time in both groups. The levels of serum ALB, Hb and TG in the observation group decreased first and then increased, while the levels mentioned above in the control group decreased gradually; furthermore, there was an interaction between early rehabilitation exercise, enteral nutrition intervention and intervention time (P＜0.05). The levels of TNF-α, IL-2 and IL-6 in the two groups decreased gradually with the extension of intervention time, and an interaction was expressed between early rehabilitation exercise, enteral nutrition intervention and intervention time (P＜0.05). After 8 weeks of discharge, the BI scores of the two groups increased significantly, and the NIHSS scores decreased significantly. Compared with the control group, the observation group yielded a higher score of BI, whereas a lower score of NIHSS, with statistically significant differences (P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups during the intervention (P＞0.05). ConclusionEarly rehabilitation exercise combined with immune enteral nutrition can effectively improve the nutritional status of elderly patients with severe stroke, relieve inflammatory responses and promote recovery of neurological function, which is worthy of promotion and application.