重型颅脑损伤后肠外与肠内营养价值比较

The clinical evaluation of parenteral and enteral nutritional support in patients with severe craniocerebral injury

目的：比较各种营养支持途径对重型颅脑损伤及特重型颅脑损伤治疗的合理性及临床价值。方法：对格拉斯哥昏迷评分（ＧＣＳ）≤５ 分的１７ 例特重型颅脑损伤者实施早期全胃肠外营养（ＴＰＮ）、６～１０ 日后逐渐过渡至肠内营养（ＥＮ）的序贯营养支持；与２０ 例采用传统的延迟性胃肠内营养的同类患者进行对照。另将８４ 例ＧＣＳ≤８ 分重型颅脑损伤患者分为ＴＰＮ ＥＮ 序贯营养组、单纯ＴＰＮ 及ＥＮ ３ 组，进行有关营养指标及早、晚期并发症、预后的临床观察及统计。结果：重型及特重型颅脑损伤患者能从早期的ＴＰＮ 途径中获得较充分的能量和蛋白合成所必需的成分，１ 周时血糖控制程度、血清总蛋白、白蛋白等指标均优于对照组（Ｐ均＜ ０．０５）。根据病情，７～１０ 日后逐渐过渡至ＥＮ 符合伤者的病理、生理要求，采用该营养支持途径的早、晚期并发症均少于对照组，预后优于对照组（Ｐ均＜ ０．０５）。结论：重型颅脑损伤后进行合理营养支持对预后有重要的临床价值，早期肠外、１

Objective:To evaluate the clinical value of various nutritional support regimes in severe and extra severe craniocerebral injury.Methods:The patients with extra severe craniocerebral injury (GCS≤5) were given early total parenteral nutrition (TPN) and switched to enteral nutrition (EN) after 6~10 days.The controls were 20 similar patients who were given conventional delayed EN.In addition,84 patients (GCS≤8) were divided into three groups:TPN followed by EN nutrition;simple TPN and simple EN.Nutritional parameters,early or late complications and prognosis were observed and evaluated.Results:With TPN,the patients could receive adequate energy and ingredients of protein synthesis.At the same time,the blood glucose,serum total protein and albumin values were superior to the controls (all P <0 05).The nutrition regime was switched to EN after 7~10 days according to the patient′s condition.As a result,the early or late complications were less than the controls,and the prognosis were markedly improved compared with the controls (both P <0 05).Conclusions:Available nutritional support to the patients with severe craniocerebral injury plays an important role in the improvement of their prognosis and TPN to be followed by is a rational nutritional support regimen.