早期小剂量起始肠内营养对创伤性脑损伤患者预后的影响

Influence of low dose of starting early enteral nutrition on prognosis in patients with traumatic brain injury

目的探讨早期小剂量起始肠内营养对创伤性脑损伤(TBI)患者预后的影响。方法将46例创伤性颅脑损伤患者随机分为观察组和对照组,每组23例。两组患者在积极临床救治同时于入院后12h内给予肠内营养支持,目标剂量为25kcal/(kg·d)。对照组给予早期快速达到目标剂量的肠内营养,即以25mL/h速度起始,以后12h增加25mL/L,直到达到目标剂量。观察组给予早期小剂量起始肠内营养,即以10mL/h小剂量起始,患者在1周内逐渐增加到目标剂量。比较两组患者伤后1周内血糖大于7.8mmol/L的次数及胰岛素总用量,不良反应发生情况及随访2个月的格拉斯哥结局评分(GOS)。结果观察组伤后1周内血糖大于7.8mmol/L的次数及胰岛素用量明显低于对照组(P<0.05)。观察组患者胃潴留、腹泻等肠内营养不耐受现象的发生率明显低于对照组(P<0.05),而两组随访2个月的GOS差异无统计学意义(P>0.05)。结论 TBI患者早期给予小剂量起始的肠内营养有利于控制血糖,降低患者胃肠道对营养液不耐受的发生率,更能使患者获益。

Objective To observe the efficacy of low dose of starting early enteral nutrition in the patients with traumatic brain injury （TBI） .Methods 46 patients with TBI were randomly divided into the observation group and the control group with 23 cases in each group .The actively clinical treatment was given to all the patients and enteral nutrition was simultaneously given within 12 h after admission .The target dose of enteral nutrition was 25 kcal/（kg . d） .The initial dose in the control group was 25 mL /h and increased with a speed of 25 mL /L each 12 h until reaching the target dose .The initial dose in the observation group was 10 mL /h and reached the target dose within 1 week .The times of serum glucose concentration above 7 .8 mmol/L and total insulin amount with 1 week were compared between the two groups .The occurrence situation of adverse reactions and scores of GOS after 2month follow up were also compared .Results The times of serum glucose concentration above 7 .8 mmol/L and the insulin amount for controlling the glucose during the first week after trauma in the observation group were significantly lower than those in the control group （P〈 0 .05） .The occurrence rates of enteral nutrition intolerance such as gastric retention and diarrhea frequency in the observation group were significantly lower than those in the control group （P〈 0 .05） . There were no statistical difference in the score of GOS outcome for 2month follow up between the two groups （P＆gt;0 .05） .Conclusion Low dose of starting enteral nutrition for the patients with TBI is propitious to control the blood glucose and reduce the occurrence rate of nutrient solution intolerance which will make the patients to obtain more benefit .