肠内营养支持治疗对重型颅脑创伤手术后患者预后的影响

Effect of enteral nutrition support therapy on the prognosis of post-operative patients with severe traumatic brain injury

目的评价肠内营养支持治疗对重型颅脑创伤手术后患者营养状况的改善作用。方法对30例符合纳入条件的重型颅脑创伤手术后患者,经鼻胃管实施24h均匀、持续泵注肠内营养制剂(瑞素),早期以低剂量(300～400ml)过渡适应,然后根据个体差异逐渐增加剂量至足量(1500～2000ml),共治疗20d～73d(平均32d)。定期检测患者体质量以及血清白蛋白、血清前白蛋白、血红蛋白水平,并观察肠内营养支持治疗的安全性。结果治疗后肠内营养组患者体质量变化与静脉营养组相比,差异无统计学意义(P>0.05);但血清白蛋白、血清前白蛋白和血红蛋白水平降低程度明显小于静脉营养组,组间差异有统计学意义(P<0.05)。在给予肠内营养支持治疗期间,患者未发生严重的消化道并发症;肝肾功能及糖脂代谢均无明显异常。结论肠内营养具有良好的辅助治疗效果且较少发生并发症,合理的肠内营养支持治疗可有效地提高重型颅脑创伤手术后患者的康复能力。

Objective To evaluate the effect of enteral nutrition support （ENS） theraphy on the improvement of nutrition condition in post-operative patients with severe traumatic brain injury （sTBI）. Methods Thirty post-operative patients with severe traumatic brain injury were treated by enteral nutrition support therapy. Nutrient （fresubin） was given continuously and evenly with infusion pump through nasogastric tube in 24 hours, for 20-73 days （mean 32 days）. Nutrient was infused in low dose （300-400 ml） for adaptation in the early stage, and then increased to full dose （1 500-2 000 ml） according to individual differences. Body mass （BM）, serum albumin （SA）, serum prealbumin （PA）, and hemoglobin （HGB） were determined regularly. Effect of enteral nutrition support therapy on the complication in digestive tract was observed. Results After treatment no differences of BM change were seen between enteral nutrition support group and parenteral nutrition group （P〉0.05）. The reduction of SA, PA, and HGB in enteral nutrition support group was significantly lesser than that in parenteral nutrition group （P〈 0.05）. During enteral nutrition support treatment, no severe digestive tract complications were seen, and no obvious abnormal liver function, renal function, glycometabolism, and lipometabolism were found. Conclusion Enteral nutrition support is quite effective and causes less complications. Rational enteral nutrition support theraphy can effectively enhance the recovery of post-operative patients with severe traumatic brain injury.