早期肠内外营养支持对重型颅脑损伤术后长期昏迷患者预后的影响

Effects of Early Enteral and Parenteral Nutrition on Prognosis of Severe Craniocerebral Trauma Patients with Long-term Postoperative Coma

目的观察早期合理肠内、肠外联合营养(EN+PN)对重型颅脑损伤术后长期昏迷患者营养状况及预后的影响。方法将74例重型颅脑损伤术后昏迷时间超过1周的患者随机分为EN+PN组与肠内营养组(EN组),每组37例。比较两组患者营养支持治疗前后血红蛋白、总蛋白、白蛋白含量及胃肠道功能紊乱、肺部感染发生率,治疗6个月后两组患者的预后情况。结果两组患者术后营养支持治疗前血红蛋白、总蛋白、白蛋白含量差异无统计学意义(P>0.05),术后第7天EN+PN组患者血红蛋白、总蛋白、白蛋白含量明显高于EN组,EN+PN组胃肠功能紊乱及肺部感染发生率明显低于EN组(P<0.05);治疗6个月后EN+PN组患者的预后明显好于EN组(P<0.05)。结论早期EN+PN联合营养支持能更好保证重型颅脑损伤术后长期昏迷患者的营养供给,改善患者术后的营养状况,减少消化道功能紊乱和肺部感染等并发症的发生。

Objective To observe the effects of early enteral and parenteral nutrition（ EN ＋ PN） on the prognosis of severe craniocerebaral trauma patients with long-term postoperative coma. Methods Seventy-four severe craniocerebaral trauma patients whose coma time more than one week were randomly divided into enteral and parenteral nutrition group（ group EN ＋ PN） and enteral nutrition group（ group EN）,with 37 cases in each group. The contents of hemoglobin,total protein and albumin before and after treatment,incidences of gastrointestinal dysfuction and pulmonary infection,and patients＇ prognosis 6 months after treatment were compared between two groups. Results Before nutrition treatment was conducted,there were no significant differences in the contents of hemoglobin,total protein,albumin after operation between two groups（ P〉0. 05）. The contents of hemoglobin,total protein and albumin in group EN ＋ PN were significantly higher than those in group EN 7 days after operation,while the incidences of gastrointestinal dysfuction and pulmonary infection were significantly lower than those in group EN（ P〈0. 05）. The patients＇ prognosis in group EN ＋ PN was better than that in group EN 6 months after treatment（ P〈0. 05）. Conclusion Early enteral and parenteral nutrition provides better nutrition for severe craniocerebaral trauma patients with long-term postoperative coma,which can improve the patients＇ nutritional status and reduce the incidences of complications such as gastrointestinal dysfunction and pulmonary infection.