重度颅脑损伤后不同营养支持途径合理性的临床评价

Clinical evaluation of rationality of nutrition support in the cases of serious rerebral injuries

目的评价重度颅脑损伤后早期不同营养支持途径的合理性及临床意义。方法将GCS≤8分的重度颅脑损伤患者随机分成A组（肠外、肠内序贯营养支持组）、B组（单纯肠外营养组，PN）、C组（单纯肠内营养组，EN），每组28例。伤后48～72小时给予不同的营养支持，观察各组营养状态的变化及早、晚期并发症的发生率和预后。结果伤后1周时，A、B组血清总蛋白、白蛋白、血红蛋白等指标优于C组，早期并发症少于C组（P＜0．05）。2周时三组上述指标虽略有高低，统计学差异无显著性（P＞0．05），但B、C组的并发症高于A组（P＜0．05）。按GCS预后评定A组预后优于B、C两组（P＜0．05），死亡率A组最低。结论重度颅脑损伤后早期肠外、一周后过渡至肠内营养支持是较为合理的营养支持途径。

objective To evaluate rationality and clinical significant of different nutrition surpport in the cases of serious cerebral injuries. Mothods The cases of serious cerebral injuries, whose GCS≤8, were divided randomly into 3 groups. While group A (PN to EN sequently), group B(PN only), group C(EN only), each group had 28 cases. They were given different nutritbo support in 48 ~ 72 hours after injury. The change of blood glucose, bldri electroyte, blood total protein, blood albumin with blood hemoglobin was observed. At same time, we observed the complication and prognosis of eary stage and late stage. Results One week late after injury, total serum protein, albumin, hemoglobin and the other indicators of group A and group B are better than these of group C, and the complication of group A and group B is less than those of group C (P < 0. 05 ). Two weeks later, although the indicators of 3 groups are similar and there is no statistical significant difference (group A. The prognosis of group A is hetter than that of group B and group C, depending on GCS prognosis evaluation, and group A had the lowest mortality rate. Conclusions To the prognosis, rational nutrition support had very important clinical significant. PN at early stage and changing from PN-EN in one week is rational nutrition support.