早期肠内营养在重型颅脑损伤合并应激性高血糖中的应用价值

Clinical outcomes of early enteral nutrition on severe traumatic brain injury patients with stress hyperglycaemia in acute stage

目的探讨早期肠内营养在重型颅脑损伤合并应激性高血糖中的应用价值。方法回顾性分析60例重型颅脑损伤合并应激性高血糖患者的临床资料,根据给予肠内营养的时间不同分为早期肠内营养组(入院后8小时)与延迟肠内营养组(入院后48小时),观察两组患者应激性高血糖的控制情况、低血糖发生率、感染并发症发生率、死亡率等。结果与延迟肠内营养组相比,早期肠内营养组肠内营养第7天的平均血糖、胰岛素使用总时间与低血糖发生率均明显降低,且差异有统计学意义(P<0.05);肺部感染发生率明显低于延迟肠内营养组,且差异有统计学意义(P<0.05);消化道出血、呼吸机使用时间以及28天死亡例数均低于延迟肠内营养组,但差异无显著统计学意义(P>0.05)。结论早期肠内营养有利于重型颅脑损伤应激性高血糖的控制,对于降低住院期间的感染发生率有着积极意义,但是暂未发现其可以改善患者的预后。

Objective To investigate the role of early enteral nutrition in severe head injury patients with stress hyperglycemia.Methods Sixty cases of severe head injury complicated with stress hyperglycemia were recruited and a retrospective analysis from these patients was performed.According to the given enteral nutrition time,.the patients were divided into early enteral nutrition group（beginning from 8 hours after admission,n =30）and delayed enteral nutrition group（beginning from 48 hours after admission,.n=30）..Quality in evaluating diabetes control,hypoglycemia,and complications were observed and analyzed.Results Compared with delayed enteral nutrition group,the patients in early nutrition group displayed more reasonable average blood glucose after seven days of enteral nutrition,shorter the duration of insulin use and lower the occurrence of hypoglycemia（P〈0.05）.Meanwhile,the incidence of pulmonary infection was also lower in early enteral nutrition group than in delayed enteral nutrition group（P〈0.05）.There were no statistical significance in gastrointestinal hemorrhage,ventilation time and 28-day mortality.Conclusion The present findings indicate the early enteral nutrition can effectively improve the stress hyperglycemia and the hospital infection after severe head injury,but not bring beneficial effects on prognosis.