不同能量密度肠内营养制剂在急性重型创伤性脑损伤机械通气患者中的疗效观察

Observation on therapeutic effects of different energy densities of enteral nutrition preparations on mechanical ventilation patients with acute severe traumatic brain injury

目的探讨急性重型创伤性脑损伤(sTBI)机械通气(MV)患者应用不同能量密度肠内营养(EN)制剂的临床疗效。方法选择2015年7月至2017年12月杭州市萧山区第一人民医院重症医学科收治的急性sTBI行MV患者60例,根据营养制剂能量密度的不同分为两组。对照组30例采用标准能量密度EN制剂鼻饲(能量密度3.35~4.19kJ/mL),观察组30例采用较高能量密度EN制剂鼻饲(能量密度5.44~6.28kJ/mL)。比较两组患者治疗前后营养状况指标,包括前白蛋白(PA)、白蛋白(Alb)、球蛋白(Glo)、血红蛋白(Hb)、EN5d和1周热卡达标率以及MV时间、并发症发生率。结果两组治疗前各营养状况指标比较差异无统计学意义(均P>0.05)。两组治疗后比较,观察组5d及1周热卡达标率明显高于对照组〔5d:66.67%(20/30)比50.00%(15/30),1周:81.33%(25/30)比70.00%(21/30),均P<0.05〕,MV时间明显少于对照组(h:92.48±12.04比128.88±16.29,P<0.05);而且观察组EN21d后PA、Alb、Hb、Glo均显著高于对照组〔PA(g/L):0.28±0.11比0.15±0.04,Alb(g/L):36.52±5.79比29.63±2.74,Hb(g/L):92.40±9.50比81.10±8.60,Glo(g/L):24.42±1.73比18.19±3.59,均P<0.05〕。并发症方面:观察组腹胀、腹泻、便秘等胃肠道不适并发症发生率为36.6%(11/30),而对照组为66.7%(20/30),两组比较差异有统计学意义(P<0.05)。结论高能量密度EN制剂可以较好改善急性sTBI行MV患者的营养状况,减少了MV时间及并发症的发生率,值得临床推广。

Objective To discuss the clinical effects of different energy densities of enteral nutrition (EN) preparations on mechanical ventilation (MV) patients with acute severe traumatic brain injury (sTBI). Methods Sixty MV patients with acute sTBI admitted to the Department of Critical Care Medicine of Hangzhou Xiaoshan District First People's Hospital from July 2015 to December 2017 were divided into two groups according to different energy densities of nutritional preparations. Thirty patients of the control group were given nasal feeding with standard energy density EN (energy density 3.35 - 4.19 kJ/mL) and 30 patients of the observation group were given nasal feeding with relatively higher energy density (energy density 5.44 - 6.28 kJ/mL). The indexes of nutritional status between the two groups before and after treatment were compared: including prealbumin (PA), albumin (Alb), globulin (Glo), hemoglobin (Hb), 5-day and 1-week heat calorie compliance rates of reaching target calories, MV time and incidence of complications. Results There were no statistically significant differences in nutritional indicators before treatment between the two groups (all P > 0.05). The compliance rates of reaching target calories of the observation group on the 5 and 7 days after treatment were significantly higher than those in the control group [5 days: 66.67% (20/30) vs. 50.00% (15/30), 1 week: 81.33% (25/30) vs. 70.00% (21/30), both P < 0.05], and the MV time was significantly lower than that in the control group (hours: 92.48±12.04 vs. 128.88±16.29, P < 0.05); the levels of PA, Alb, Hb, Glo were significantly higher in the observation group than those in control group on the 21st day after treatment [PA (g/L): 0.28±0.11 vs. 0.15±0.04, Alb (g/L): 36.52±5.79 vs. 29.63±2.74, Hb (g/L): 92.40±9.50 vs. 81.10±8.60, Glo (g/L): 24.42±1.73 vs. 18.19±3.59, all P < 0.05]. Complications: the total incidence of abdominal distension, diarrhea and constipation of the observation group was 36.6% (11/30), while that of the control group was 66.7% (20/30), the difference between the two groups being statistically significant (P < 0.05). Conclusion High energy density enteral nutrition can improve the nutritional status of the organisms of MV patients with acute sTBI, reduce the time of MV and the incidence of complications, thus it is worthy to be widely applied clinically.