早期肠道内营养在重型脑外伤治疗中的作用

The effects of early enteral nutrition on the treatment of patients with severe head injury

目的 研究早期肠道内营养 (EN)在重型脑外伤患者治疗过程中的作用。方法 对 30例重型脑外伤患者行早期肠道内营养 ,取同期的 30例重型脑外伤患者行早期肠道外营养 (PN) ,并动态观察其白蛋白、淋巴细胞数 (LC)、谷草转氨酶 (ALT)、血糖、颅内压 (ICP)、哥拉斯哥评分 (GCS)、体重、应激性溃疡发病率等变化。结果 伤后 10天 ,EN组与PN组的白蛋白、LC、ICP、体重无显著差异 (P >0 .0 5 ) ,但伤后 10天 ,EN组ALT低于PN组 ,分别为 (35± 4.8)u/L ,(38± 4.2 )u/L ,(P <0 .0 5 ) ;EN组血糖也低于PN组 ,分别为 (8.4± 3.4)mmol/L ,(10 .3± 3 .6 )mmol/L ,(P <0 .0 5 ) ;EN组GCS评分高于PN组 ,分别为 (10 .6± 2 .7)分 ,(8.9±2 .6 )分 ,(P <0 .0 5 )分 ;EN组应激性溃疡发病率低于PN组 ,分别为 10 %和 33 .3% (P <0 .0 5 )。结论 早期肠道内营养与肠道外营养具有同样的营养价值 ,但在调节内脏功能、降低血糖、保护肝脏、降低应激性溃疡的发病率。

Objective To investigate the effects of early enteral nutrition in the severe head injured patients.?Methods The 60 patients with GCS of 5 to 8 were randomly divided into two groups:30 patients with enteral nutrition(EN),the others with parenteral nutrition(PN).In both groups,the serum albumin and glucose levels,lymphocyte count,ALT,GCS,body's weight and the rate of stress ulcer were observed 2,5,8 and 10 days post head injury.?Results The serum albumin levels,lymphocyte count,ICP and body's weight,showed no signifitcant difference in both groups within 10 days after head injury,but in EN group,the ALT(35±4.8 u/l),the serum glucose (8.4±3.4mmol/l) and the rate of stress ulcer(10%) were all signifitively lower than that of the PN group (38±4.2u/l,10.3±3.6mmol/l,33%),the GCS in EN group(10.6±2.7) was higher than that in PN group(8.9±2.6).?Conclusion There was no difference in nutritional evaluation between the EN and PN group,but the early enteral nutrition is superior in lowing the level of serum glucos,the rate of stress ulcer and promoting nurological recovery to the parenteral nutrition.