早期营养目标策略治疗重型颅脑损伤的临床对照研究

A controlled clinical study on early stage nutritional target strategic treatment of severe craniocerebral injury

目的探讨重型颅脑损伤患者实施早期营养目标策略的可行性及临床效果。方法将符合条件的重型颅脑损伤患者随机分为实验组和对照组，实验组42例实施优化流程的早期营养目标策略，对照组41例实施早期留置胃管并每日增加滴注速度的肠内营养方法，两组肠内营养实施24h仍达不到营养目标量时辅以肠外营养。检测比较两组氮平衡情况、需联合肠外营养的比例、达到肠内营养目标量的时间、机械通气时间、ICU住院天数、并发症情况等。结果患者均能达到肠内营养目标策略，但实验组需联合肠外营养的比例小于对照组，实验组达到氮平衡、肠内营养目标量的时间、机械通气时间、平均ICU住院天数明显短于对照组，实验组患者对胃肠道的不耐受、肺部感染、血糖紊乱发生率明显少于对照组。结论早期实施优化流程的肠内营养方式能尽快达到营养治疗目标。

Objective To explore and evaluate the feasibility and clinical effects of early - stage nutritional target strategic treatment in severe craniocerebral injury cases. Methods The patients of severe craniocerebral injury were randomly divided into research group and control group. 42 cases of research group accepted early - stage nutritional target strategic treatment, in which the enteral nutrition of integral protein fiber type was infused through naso - intestinal tube uniformly and optimally in the early stage. 41 cases of control group accepted enteral nutrition through naso - gastric tube in the early stage and the infusion rate was increased every day. Parenteral nutrition was added when the target nutritional level was not achieved after 24 hours of enteral nutrition. The factors of nitrogen balance status, necessary proportion of parenteral nutrition, time to achieve the target level of enteral nutrition, time of mechanical ventilation, time of ICU hospitalization and the complications were recorded and compared between the two groups. Results All the patients achieved the strategic target level of enteral nutrition. The proportion of parenteral nutrition in the research group was less than that in the control group. The time to achieve nitrogen balance and target level of enteral nutrition, time of mechanical ventilation and time of ICU hospitalization were significantly shorter in the research group. The incidence rates of gastrointestinal intolerance, pneumonia and blood glucose disturbance were significantly lower in the research group. Conclusions Optimized enteral nutrition in the early stage of severe craniocerebral injury may achieve the target level of nutrition and nitrogen balance in a short term. It could reduce the proportion of parenteral nutrition, decrease the time of mechanical ventilation and ICU hospitalization, and decrease the incidence of gastrointestinal intolerance and pneumonia.