摘要
目的探讨早期肠内营养支持对重型颅脑损伤患者并发症及患者预后的影响。方法对我科自2010年10月至2015年10月收治的135例重型颅脑损伤患者的营养支持治疗方案做前瞻性研究,随机分成实验组(早期肠内营养)和对照组(早期肠外营养)。实验组(68例)于伤后6-24h内持续胃内泵入肠内营养液,并辅助肠外营养补充能量不足,对照组(67例)于伤后4-6d给予肠内营养。分析两组间的各项营养指标、生化指标、意识恢复程度、并发症及死亡率。所有病例均随访3个月。结果实验组各项营养指标较对照组相比氮平衡指标优于对照组(P<0.05);消化道出血发生率(4.4%)低于对照组(14.9%),P<0.05;肝肾功能损害发生率(2.9%)低于对照组(14.9%),P<0.05;第7d C反应蛋白低于对照组,P<0.05;肺部感染发生率(58.8%)低于对照组(76.1%),P<0.05。实验组患者意识程度GCS评分第2周(9.4±2.3)、第3周(10.3±1.9)、第4周(13.5±1.8)分别优于同时间点的对照组(P<0.05);3月后实验组GOS评分为3.8±0.8,优于对照组为3.1±0.6,P<0.05;实验组、对照组病死率分别为13.2%、19.4%,无统计学意义,P>0.05。结论重型颅脑损伤患者早期肠内营养能改善患者营养状态,减少并发症,促进患者恢复。
Objective To explore the complications and prognosis of patients with severe traumatic brain injuries who were supported with early enteral nutrition. Methods 135 cases of patients with severe traumatic brain injuries were cared in our department and assisted by nutrition support treatment from October 2010 to October 2015,were conducted by prospective studies.These patients were randomly divided into experimental group（early enteral nutrition） and control group（early parenteral nutrition）. In the experimental group（68 cases）,patients were supported by continuous pumping nutrition fiber into the stomach and adding parenteral nutrition supplement in 6 to 24 hours after injury. In the control group（67 cases）,patients were totally given parenteral nutrition,and gradually given enteral nutrition after in 4 to 6 days later. Nutrition indicators,biochemical index,the degree of consciousness recovery,complications and mortality were analyzed between the two groups. All cases were followed up for 3 months. Results Nitrogen balance nutrition indicator of experimental group was better than control group,P〈0.05. The incidence of gastrointestinal bleeding in the experimental group（4.4%） was lower than the control group（14.9%）,P〈0.05. And the incidence of liver and renal function impairment in the experimental group（2.9%） was also lower than the control group（14.9%）,P〈0.05. The level of CRP in 7 days later of experimental group was lower than the control group,P〈0.05. The incidence of pulmonary infection of experimental group（58.8%） was lower than the control group（76.1%）,P〈0.05. Sepsis,liver and renal functional lesions were lower than the control group,while no statistical significance. Experimental group patients＇ consciousness GCS score at 2 weeks（9.4±2.3）,3 weeks（10.3±1.9）,4 weeks（13.5±1.8） was respectively superior to the same time of the control group（P〈0.05）. GOS score of the experimental group（3.8±0.8） three months after injury,was better than that of control group at the same time（3.1±0.6）,P〈0.05.The fatality rate of experimental cases was 13.2%,while it was 19.4% in the control cases,P〈0.05. Conclusion patients with severe traumatic brain injury supported with early enteral nutrition can improve nutritional status,reduce complications,and promote patients recover.
出处
《江西医药》
CAS
2016年第3期198-202,共5页
Jiangxi Medical Journal
关键词
重型颅脑损伤
早期肠内营养
肠外营养
营养支持
Severe traumatic brain injuries
Early enteral nutrition
Parenteral nutrition
Nutritional support
