亚低温联合肠内营养治疗重型颅脑损伤临床疗效观察及护理

Clinical observation and nursing of mild hypothermia combined with enteral nutrition in treatment of severe traumatic brain injury

目的研究亚低温联合肠内营养治疗重型颅脑损伤临床疗效及护理要点。方法将海南省儋州市第一人民医院120例确诊为重型颅脑损伤患者随机分为实验组和对照组,每组60例,实验组采用亚低温联合肠内营养治疗,对照组采用亚低温联合肠外营养治疗。观察比较实验组和对照组治疗前后身体质量指数(body mass index,BMI)、三角肌皮褶厚度、血红蛋白(hemoglobin,Hb)、血糖(blood glucose,BG)、乳酸(lactic acid,LAC)、血浆白蛋白(albumin,ALB),上消化道出血、肺部感染、急性肾功能衰竭、水电解质紊乱等并发症的发生率,多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)发生率以及两组患者治疗期间的死亡率。结果治疗后实验组Hb与ALB均高于对照组,差异具有统计学意义(P<0.05);治疗后实验组LAC与BG均低于对照组,差异具有统计学意义(P<0.05);治疗后实验组BMI和三角肌皮褶厚度均高于对照组,差异具有统计学意义(P<0.05);治疗期间实验组上消化道出血、肺部感染、急性肾功能衰竭、水电解质紊乱等并发症的发生率均低于对照组,差异具有统计学意义(P<0.05)。治疗期间,实验组MODS发生率以及死亡率低于对照组,差异具有统计学意义(P<0.05)。结论亚低温疗法联合肠内营养治疗重型颅脑损伤患者,显著改善患者的营养状况,减少并发症的发生,降低患者的死亡率。

Objective To study clinical observation and nursing main point of mild hypothermia combined with enteral nutrition in treatment of severe traumatic brain injury. Methods 120 cases of patients with severe head injury were randomly divided into experimental group and control group; each group of 60 cases, the experimental group was treated by mild hypothermia combined with enteral nutrition, the control group was treated by mild hypothermia combined with parenteral nutrition. The body mass index （BMI）, deltoid skin fold thickness; hemoglobin （Hb）, blood glucose （BG）, lactic acid （LAC）, albumin （ALB）, upper digestive tract hemorrhage, pulmonary infection, acute renal failure, electrolyte disturbance, incidence rate of complication of multiple organ dysfunction syndrome （MODS） incidence and mortality rate during treatment in two groups before and after treatment were observed and compared. Results After treatment, Hb and ALB of the experimental group were higher than those in the control group, with significantly differences （P 〈 0.05）; after treatment, LAC and BG of the experimental group were lower than the control group, with significantly differences （P 〈 0.05）; after the treatment, the BMI and deltoid skin fold thickness of the experimental group were higher than that of the control group, with significantly differences （P 〈 0.05）; during the treatment, the upper digestive tract hemorrhage, pulmonary infection, acute renal failure, electrolyte disturbance complication rates of the experimental group were lower than the control group, with significantly differences （P 〈 0.05）. During treatment, the experimental group MODS incidence and mortality rates were lower than the control group, with significantly differences （P 〈 0.05）. Conclusion Mild hypothermia combined with enteral nutrition therapy in the treatment of patients with severe brain injury, can improve the nutritional status of patients, reduce complications, reduce patient mortality.