重度颅脑损伤后各营养支持途径合理性的临床评价

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

目的 :评价重度颅脑损伤后早期各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 ,TPN)、C组 (单纯肠内营养组 ,EN) ,每组 2 8例 ;伤后 48～ 72h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组在血清总蛋白、白蛋白、血红蛋白等指标上优于C组 ,并且早期并发症少于C组 (P <0 0 5 )。2周时 3组上述指标虽略有高低 ,统计学无显著差异 (P >0 0 5 ) ,但B、C组的并发症高于A组(P <0 0 5 ) ;按GOS预后评定A组预后优于B、C两组 (P <0 0 5 ) ,病死率A组最低。结论

Objective:To evaluate the rational and clinical significance of different nutrition supports in cases of cerebral injuries.Methods:The cases of serious cerebral injuries,whose GCS≤8,were randomly divided into 3 groups:Group A (TPN to EN sequently),Group B(TNP only),Group C(EN only).There were 28 cases in each group.They were given different nutritional supports in 48～72 hours after being injured.The changes in blood total protein,blood albumin with blood hemoglobin were observed.At the same time,we observed the complication and the prognosis of early stage and later stage.Results:One week after being injured,blood total protein,blood albumin,blood hemoglobin and the other indicators in Group A and Group B are better than that in Group C.And the complication of Group A and Group B is less than that of Group C(P<0 05).Two weeks later,although the indicators in з groups are about the same with no statistical significance(P>0 05).The complication rates of Group B and Group C are higher than that of Group A.The prognosis of Group A is better than that of Group B and Group C,according to GOS prognosis evaluation,and Group A has the lowest mortality rate.Conclusion:Rational nutrition support plays an important role in the prognosis of serious cerebral injuries.TPN at the early stage and changing to TPN EN in one week are suggested.