重型创伤性脑损伤机械通气患者实施规范化肠内营养流程的效果分析

Clinical efficacy of implementation of standardized enteral nutrition in patients with severe traumatic brain injury undergoing mechanical ventilation

目的探讨重型创伤性脑损伤(sTBI)机械通气(MV)患者采取规范化肠内营养(EN)流程的实施效果及其对预后的影响。方法选取余姚市人民医院重症医学科2016年1月至2017年12月收治的sTBI行MV患者88例,以2017年1月1日实施规范化EN治疗流程为分界点,将患者分为对照组(42例)和试验组(46例)。两组均实施早期EN治疗;试验组在对照组基础上实施规范化EN治疗流程。比较两组开始EN治疗时间、首次排便时间、能量供给达标率、蛋白质供给达标率、MV时间、ICU住院时间、28d病死率的差异。结果试验组开始EN治疗时间(h:25.61±8.74比32.79±8.63)和首次排便时间(d:3.03±0.79比3.61±0.89)均早于对照组(均P<0.05);试验组EN治疗5d和7d能量供给达标率〔5d为(44.83±13.99)%比(37.59±10.88)%,7d为(68.07±10.68)%比(62.69±9.87)%〕及蛋白质供给达标率〔5d为(31.93±9.49)%比(27.06±8.08)%,7d为(62.09±9.91)%比(54.55±11.27)%〕均较对照组显著提高(均P<0.05),MV时间(h:9.24±2.91比10.67±3.41)、ICU住院时间(d:12.09±3.37比13.93±4.98)均显著低于对照组(均P<0.05)。试验组和对照组28d病死率比较差异无统计学意义〔21.74%(10/46)比19.05%(8/42),P>0.05〕。结论sTBI行MV患者采取规范化EN流程的实施效果明显,可提高EN营养达标率,缩短MV时间和ICU住院时间。

Objective To investigate the clinical efficacy of implementation of standardized enteral nutrition (EN) and its effects on prognosis in patients with severe traumatic brain injury (sTBI) undergoing mechanical ventilation (MV). Methods Eighty-eight patients with sTBI undergoing MV admitted to the Department of Critical Care Medicine of Yuyao People's Hospital from January 2016 to December 2017 were enrolled, they were divided into a control group (42 cases) and an experiment group (46 cases) depending on the demarcation timing of January 1, 2017, the beginning time of implementing standardized EN. All the patients received early EN and conventional treatment in the two groups. Additionally, the procedure of standardized EN was implemented in the experiment group. The differences in starting time of EN, the first defecation time, the rates of EN therapeutic energy and protein supply reaching their respective targets, duration of MV and ICU stay and 28-day mortality were compared between the two groups. Results The starting time of EN (hours: 25.61±8.74 vs. 32.79±8.63) and first defecation time (days: 3.03±0.79 vs. 3.61±0.89) were significantly earlier in the experiment group than those in the control group (both P < 0.05); the rates of energy and protein supply reaching the respective targets on the 5th day and 7th day after receiving EN were all significantly higher in the experiment group than those in the control group [rates of energy supply reaching target on the 5th day: (44.83±13.99)% vs. 37.59±10.88, and on the 7th day: (68.07±10.68)% vs. (62.69±9.87)%; rate of protein supply reaching target on the 5th day: (31.93±9.49)% vs. (27.06±8.08)%, and on the 7th day: (62.09±9.91)% vs. (54.55±11.27) %, all P < 0.05]; the durations of MV (hours: 9.24±2.91 vs. 10.67±3.41) and ICU stay (days: 12.09±3.37 vs. 13.93±4.98) in the experiment group were significantly shorter than those in the control group (all P < 0.05). No statistical significant difference in the 28-day mortality was observed between the experiment group and control group [21.74% (10/46) vs. 19.05% (8/42), P > 0.05]. Conclusion The efficacy of implementation of standardized EN in patients with sTBI undergoing MV is very significant, as it can significantly improve the rate of reaching EN target, and shorten the duration of MV and ICU stay.