创伤性颅脑损伤病人早期持续小剂量肠内营养的临床研究

Randomized trial of early enteral nutrition in traumatic brain injury patients

目的:探讨创伤性颅脑损伤病人早期持续小剂量肠内营养(EN)治疗对减少并发症和改善病人预后的影响。方法:选取创伤性颅脑损伤病人42例,随机分为对照组(早期快速达到目标量)(n=22)和小剂量组(早期持续小剂量EN)(n=20)。对照组病人开始进行EN的速度为25 ml/h,每12 h增加25 ml/h,直至达到目标量。小剂量组开始进行EN的速度为10 ml/h,1周内逐步加至目标量。比较两组病人3个月的格拉斯哥结局评分、发生胃潴留和腹泻的比例、伤后1周内血糖>7.8 mmol/L的次数以及使用胰岛素的总量。结果:两组病人EN3个月后的格拉斯哥结局评分无显著性差异(P>0.05)。小剂量组发生胃潴留和腹泻的比例明显少于对照组,血糖>7.8 mmol/L的次数明显低于对照组,胰岛素使用的总量明显少于对照组(P均<0.05)。结论:对创伤性颅脑损伤病人早期持续给予小剂量EN治疗有利于控制血糖,并发症较低。

Objective：To test the hypothesis that initial low-volume （i.e.trophic） enteral nutrition would decrease complications and improve outcomes in traumatic brain injury patients.Methods：42 traumatic brain injury patients were randomly divided into atrophic group （n =20） and a full-energy group（n =22）.The patients of two groups were analyzed by Glasgow outcome scale after three months,high gastric residual volume and diarrhoea frequency,the times of serum glucose concentration above 7.8 mmol/L,and the amount of insulin used for control of blood glucose for a period （7 days）.Results：There were no statistical differences in the Glasgow outcome scale after three months between the two groups （P ＞ 0.05）.During the first week,high gastric residual volume and diarrhoea frequency of the trophic group was lower than the full-energy group （P ＜ 0.05）.The trophic group patients with serum glucose concentration above 7.8 mmol/L frequency was significantly lower than the full-energy group （P ＜ 0.05）,and the total insulin was significantly lower than the full-energy group （P ＜ 0.05）.Conclusion：Patients receiving initial trophic enteral nutrition would have a clinical outcome similar to those patients receiving initial full-energy enteral nutrition and lower frequency of feeding intolerance and less serum glucose fluctuation.