重度颅脑外伤术后患者早期营养支持的探讨

Clinical significance on the early nutritional support in postoperative patients with critical craniocerebral injury

目的探讨ICU重度颅脑外伤患者早期营养支持的临床疗效以及不同营养方法的合理性。方法将37例临床格拉斯哥昏迷评分6～8分的颅脑损伤患者随机分成早期肠内营养组(EEN)19例,肠外营养组(EPN)18例。入院48h内给予不同方法的营养支持,观察两组治疗后相关营养指标的变化、临床并发症发生情况及3周后的治疗效果。结果入院1周时,EEN组血清白蛋白指标优于EPN组(P<0.05);两组营养指标虽有高低,统计学上差异无显著性(P>0.05);EPN组并发症发生率高于EEN组(P<0.05);3个月后按日常生活能力(ADL)评定预后,EEN组优于EPN组(P<0.05)。结论重度颅脑外伤患者能够从EEN中接受机体所需要的营养成分,减少并发症发生,提高疗效而改善愈后。

Objective To investigate the clinical significance of early nutritional support for various kind of patients in critical craniocerebral injury,and the rationale of different methods of nutritional support. Methods Thirty-seven patients with Glasgow coma score （GCS） 6- 8 were randomly divided into two groups ： early enteral nutrition （EEN） group （19 cases） ; early parenteral nutrition （EPN） group （18 cases）. They were given different nuitritional supports within 48 hours after admission. Changes in nutritional parameters and the clinical complications in two groups after treatment were observed ,and the treatment effects after 3 months were compared. Results At the end of the first week after admission,nutrition parameters including albumin（Alb）, hemoglobin（Hgb）in EEN groups were better than those in EPN group（P〈0. 05）;at the end of the second week,there were differences between the two groups ,but without statistical significance（P〉0. 05）. The complications were higher in EPN groups（P〈 0. 05 or P〈0. 01）. The outcome was assessed 3 months after admission in terms of activity of daily life （ADL）,and the result was better in EEN group than that in EPN（P〈0. 05）. Conclusion Various kind of patients in critical craniocerebral injury could be benefited with EEN,and complications could be reduced with improved prognosis.