个体化肠内营养液在重型颅脑损伤患者中的应用

Application of individualized enteral nutrition liquid for patients with severe craniocerebral injury

目的探讨个体化自配营养液在重型颅脑损伤患者肠内营养支持中的应用效果。方法将142例重型颅脑损伤患者分为个体化自配肠内营养液组（A组,50例）、商品营养液组（B组,46例）和普通流质组（C组,46例）。A组给予同济大学附属第十人民医院营养科配制的营养液,按临床需求供应4~6次/d;B组给予瑞代,用量遵循使用说明及临床实际需求;C组给予家属自备的营养物（普通流质饮食）,根据患者需要,进食4~6次/d。3组间其他治疗措施相同。比较各组患者近、远期的营养状况及临床并发症和临床预后的差异。结果 C组的上臂围及上臂肌围均显著低于A、B组（P值均〈0.05）。C组的淋巴细胞计数及白蛋白、前白蛋白、运铁白蛋白含量均显著低于A、B组（P值均〈0.05）。B组给予营养液15 d的成本显著高于A、C组（P值均〈0.05）。住院期间,A、B组的肺部感染、泌尿系统感染、腹泻及褥疮的发生率均显著低于C组（P值均〈0.05）,A、B组的预后良好率分别为80.0%、80.4%,显著高于C组的60.9%（P值均〈0.05）。结论个体化自配营养液用于重型颅脑损伤患者肠内营养支持治疗,能显著提高患者的营养状况,改善临床预后,且价格适中,是一种安全、有效、经济的肠内营养方式。

Objective To study the clinical effects of self-prepared individualized enteral nutritional liquid for patients with severe craniocerebral injury.Methods Totally 132 patients with severe craniocerebral injury were randomly divided into the self-prepared individualized enteral nutrition group（group A,50 cases）,traditional liquid group（group B,46 cases）,and common liquid group（group C,46 cases）.The self-prepared individualized enteral nutrition liquid was prepared by the nutrition department of our hospital,which was given to patients for 4-6 times/day.Routine nursing and treating methods were the same for different groups.The nutritional status,clinical complications and clinical prognoses of patients were compared between the three groups.Results There were no significant differences in the body nutritional status,biochemical index and clinical prognosis between group A and group C（P0.05）.The index of arm muscle circumference,prealbumin,serum transferrin and clinical prognosis,fitness rate were significantly lower in group C compared with other two groups（P0.05）.The cost in group B was significantly more than those of the other two groups at day 15（P0.05）.The incidences of pulmonary infection,urinary tract infection,diarrhea,and bedsore in group A,B were significantly lower than those in group C（P0.05）;and the recovery rates of group A and B（80.0%,80.4%） were significantly higher than that in group C（60.9%,P0.05）.Conclusion Self-prepared individualized enteral nutritional liquid can effectively improve the nutritional conditions and prognoses of patients with severe craniocerebral injury,and it is a safe,effective,and economical way for enteral nutrition support.