重型颅脑损伤病人序贯性肠内营养治疗的研究

A preliminary controlled clinical study on the sequential enteral nutritional therapy in severe traumatic brain injury

目的:探讨重型颅脑损伤病人序贯性肠内营养(EN)治疗的方案、可行性及临床效果。方法:将59例重型颅脑损伤病人随机分为研究组和对照组。研究组30例病人采用短肽型EN制剂过渡至整蛋白型EN制剂的序贯性EN治疗方案,对照组29例开始即采用整蛋白型EN制剂,根据操作流程实施。观察两组病人达到EN目标量的时间、需联合肠外营养(PN)治疗的比例、低清蛋白(ALB)血症率、喂养相关并发症、平均入住ICU天数等指标。结果:两组病人均能达到EN目标治疗,研究组开始EN治疗后达到EN目标量的时间早于对照组(P<0.05),联合PN治疗的比例小于对照组(P<0.05),ALB水平高于对照组(P<0.05),腹胀发生率低于对照组(P<0.05)。两组间其他喂养相关并发症和平均入住ICU时间无统计学差异。结论:对重型颅脑损伤后病人尤其是肠道吸收功能障碍者推荐采用序贯性EN支持治疗。

Objective： Our purpose was to explore and discuss the strategies,feasibility,and clinical effect of sequential enteral nutritional therapy in severe traumatic brain injury. Methods： The severe traumatic brain injury patients meeting the criteria were randomly divided into research group and control group. According to the operation process,30 cases in the research group underwent sequential enteral nutritional therapy which transformed gradually from short-peptide to total-protein enteral nutrition,while 29 cases of control group underwent total-protein enteral nutrition only. The data of two groups,including the time to target amount of enteral nutrition,proportion of necessary combined parenteral nutrition,hypoproteinemia rate,feeing-associated complications,and average hospitalization,was recorded and compared. Results： Patients could achieve the target amount of enteral nutrition in both groups,but in the research group,the time to target amount was shorter（P〈0. 05）,the proportion of combined parenteral nutrition was lower（P〈0. 05）,the albumin level was higher（P〈0. 05）,and the rate of abdominal distention was lower（P〈0. 05）. There was no statistical significance in the rate of other feeing-associated complications and the average hospitalization. Conclusion： The sequential enteral nutritional therapy initiating with short-peptide enteral nutrition can be applied as a recommended strategy in traumatic brain injury patients with malabsorption.