早期肠内营养支持在重型颅脑损伤治疗中的效果

The effect of early nutrition in the treatment of patients with severe head injury

目的探讨早期肠内营养支持在重型颅脑损伤治疗中的作用。方法将符合条件的患者随机分为治疗组和对照组,治疗组于伤后自第2天始胃管内给予10%GS100ml+美兰1支,观察4h后,尿内若有美兰染色,证明肠道有吸收功能,后给5%GNS500ml持续胃管内泵入,第3天给予百普利鼻饲500ml持续24h泵入,第4天加用能全力500ml持续24h泵入,逐渐增加肠内营养液,1周后达全量;期间胃肠外所需热量均由卡文供给。对照组于受伤2d后予肠外营养支持,等肠鸣音出现后(5～7d)开始渐转为肠内营养。并观察两组血糖、血清总蛋白、谷丙转氨酶、淋巴细胞计数、血生化离子、肝功、肾功,同时观察各组并发症的发生率和预后。结果治疗组的营养指标明显优于对照组(P<0.05),并发症低于对照组(P<0.05),预后良好。结论严重颅脑损伤早期肠内营养支持有利于脑损伤患者尽早康复。

Objective To explore the action of early nutrition in the treatment of patients with severe head injury.Methods The eligible patients were divided into the treatment group and control group,the treatment group from the second days after injury in the beginning of gastric tube to give 10% GS100 ml ＋ Methylene Blue,after observed 4 hours,it was proofed the intestinal absorption if Methylene Blue dye in the urine,then 5% GNS 500 ml was contined gastric tube into the pump.the third day,continued to give peptison 500 ml nasal pump lasting 24 h,the fourth day was added to the nutrison fibre 500 ml contined 24 h infusion,and increasing enteral nutrition,up to full volume after a week.During this time,calories gastrointestinal outside was supplied all by Kabiven beginning after 36 ～ 48 h installed gastric tube.The patients of the control group were given parenteral nutrition,then would begin to enteral nutrition gradually after bowel sound appearsd（5-7 hours）.We observed two groups blood sugar,serum total protein,cereal third transaminase,lymph-cell counts,blood biochemicalions,liver,kidney,and observed reactive groups the incidence of complications and prognosis.Results The nutrition index of the treatment group was better than that of the control groups（P 0.05）,complications was lower than that of the control group（P 0.05） and prognosis was better.Conclusion Early nutrition in the treatment of patients with severe head injury is helped for the brain-damaged patients recovered as soon as possible.