肠内营养混悬液在神经外科昏迷患者鼻肠管途径营养支持中的应用

Clinical application of enteral nutritional suspension in neurosurgical coma patients through nasointestinal tube pathway

目的 观察肠内营养混悬液(TPF-FOS)应用于神经外科昏迷患者鼻肠管途径营养支持的可行性和效果。方法 选择2009年11月至2011年12月我院神经外科昏迷患者40例,随机均分为两组:观察组(n=20)和对照组(n=20)。观察组直接通过鼻肠管途径给予整蛋白营养制剂TPF-FOS,第1天500 ml,30～40 ml/h,逐渐加量至满足患者的营养要求,对照组给予序贯肠内营养治疗。行肠内营养30 d后对两组患者血清生化指标及不良反应的发生情况进行观察,所有数据采用SPSS11。5软件进行统计分析。两组血清血红蛋白(Hb)、白蛋白(Alb)、血清前白蛋白(PAB)及血清肌酐(Scr)水平组内比较用配对资料的t检验,两组年龄、体质量、格拉斯哥昏迷评分(GCS)评分、血清生化指标组间比较用成组资料的t检验,两组不良反应发生情况比较采用x2检验。结果 行肠内营养30 d时,观察组血清白蛋白、血红蛋白等指标与对照组相比差异无统计学意义(t=0.14～1.42,P＞0.05)；30 d内并发症发生差异无统计学意义(x2=0～0.36,P＞0.05)。结论 与序贯肠内营养方案相比,神经外科昏迷患者直接通过鼻肠管途径给予整蛋白营养制剂TPF-FOS,在不增加患者肠内营养相关不良事件的情况下,可以为患者恢复提供很好的营养支持。

Objective To observe the feasibility and effectiveness of enteral nutritional suspension( total protein fiber frutooligosaccharide,TPF-FOS) in neurosurgical coma patients through nasointestinal tube. Methods Forty neurosurgical coma patients hospitalized in our department of neurosurgery from November 2009 to December 2011 were equally and randomly divided into two groups,test group( n = 20) and control group( n = 20). The test group received early enteral nutritional suspension by nasointestinal tube pathway( 500 ml,30 ~ 40 ml / h for the first day,increased gradually to meet the nutritional requirements)while the control group received sequential enteral nutrition. Serum nutritional or biochemical markers and enteral nutritional complications of both groups were detected on 30th days after application of enteral nutrition. All data were analyzed by SPSS 11. 5 software. Paired t test was used to compare the serum hemoglobin( Hb),albumin( Alb),prealbumin( PAB) and serum creatinine( Scr) level of two groups,group data t test was used to compare age,weight,Glasgow coma score( GCS),serum biochemical indexes between groups,chi-square test was used to compare the adverse reactions occurrence of two groups. Results There were no significant differences in the incidence of complications( χ2= 0-0. 36,P > 0. 05) and some serum nutritional or biochemical markers( hemoglobin,albumin,prealbumin,creatinine and glutamate pyruvate transaminase) between two groups on 30th days after application of enteral nutrition( t = 0. 14-1. 42,P >0. 05). Conclusions Compared with sequential enteral nutrition,clinical application of enteral nutritional suspension though nasointestinal tube can provide effective nutritional support for neurosurgical coma patients without increasing the incidence of enteral nutritional complications.