早期肠内营养在老年重型颅脑损伤中的临床应用

Clinical application of early enteral nutrition on severe craniocerebral injury of geriatric patient

目的探讨对老年重型颅脑损伤患者采用早期肠内营养方法的临床意义及预后。方法回顾性分析70例老年重型颅脑损伤患者伤后早期营养支持情况,根据营养支持施行方法将患者分为试验组和对照组。试验组:施行早期肠内营养支持方法;对照组:伤后6d起鼻饲流质渐过渡为匀浆饮食。对两组患者伤后体重、血清生化指标、胃肠道功能障碍症状、伤后格拉斯哥雷迷评分(GCS)进行统计学分析。结果伤后28d试验组体重高于对照组体重,差异有统计学意义(P<0.05),对照组下降体重高于试验组,差异有统计学意义(P<0.05)。营养支持方案实施后,伤后早期(7d)试验组与对照组血清总蛋白、血清白蛋白、血红蛋白及空腹血糖差异有统计学意义(P<0.05);伤后晚期(28d)试验组与对照组血清总蛋白,血红蛋白、空腹血糖差异有统计学意义(P<0.01)。根据GCS评定,统计试验组预后良好(4～5级)21例,优于对照组14例,两组相比差异有统计学意义(P<0.05)。试验组中胃肠道并发症及因严重并发症引起死亡例数统计明显减少。结论进行早期肠内营养支持有利于老年重型颅脑损伤患者获得必需的营养物质,显著提高生存率和生存质量。

Objective To study the dinical meaning and prognosis of early enteral nutrition method on severe craniocerebral injury of geriatric patients. Methods Seventy severe eraniocerebral injury of geri- atric patients were devided into two group： test group and control group. The test group received early enteral nutrition,the control group was fed six days later after injury and finally to normal theapy. Weight,blood biochemistry examination, stomatie disfunction, glasgow coma scale（GCS） after injury were analysed. Results The test group weight was higher than the the control group after the twenty-eight days injury（ P 〈 0.05 ）, the control group weight reduction was higher than the test group （P 〈 0.05 ）. After the nutrition therapy plan was performed, the blood total protein, the blood albumin, the hemoglobin, the blood sugar before feeding had statistical significance （P 〈0.05） between the test group and the control group in early injury（7 d）. The blood total protein, the hemoglobin, the blood sugar before feeding had significant statistical （ P 〈 0.01 ） between the test group and the control group in later injury （28 d）. Depended on GCS test, the test group had better prognosis （ twenty-one cases） than the control group （ fourteen eases）, （ P 〈 0.05 ）. Stomatie disfunctions and the eases died of severe complications in the test group were obviously reduced. Conclusion Early enteral nutrition was beneficial in severe craniocerebral injury of geriatric patient, improved the survive rate and life quality.