鼻肠管肠内营养在重型颅脑损伤患者中的作用

Role of nasojejunal feeding tube nutrition in patients with severe traumatic brain injury

目的探讨经鼻肠管肠内营养在重型颅脑损伤患者中的应用效果。方法回顾性分析2012年6月至2014年12月中山大学附属第三医院重症医学科收治的54例重型颅脑损伤患者的资料。按照肠内营养方式的不同,分为鼻肠管肠内营养支持组(鼻肠组,26例)和鼻胃管肠内营养支持组(鼻胃组,28例)。在两组患者均于入住重症监护室(ICU)第2天开始给予鼻饲整蛋白制剂(瑞代),观察两组患者达到肠内营养支持目标的时间、肠外营养支持时间、营养指标(白蛋白、血红蛋白等)、入住ICU时间、感染及胃肠道并发症等的发生率。结果 (1)按照体质量计算热卡需求量,鼻肠组较鼻胃组更快达到肠内营养支持目标的时间,分别为(3.0±0.8)d和(7.7±2.5)d,两组差异有统计学意义(P<0.01)。鼻肠组较鼻胃组联合肠外营养支持的时间明显缩短,分别为(2.0±0.8)d和(6.7±2.5)d,两组差异有统计学意义(P<0.01)。(2)治疗第30天时,鼻肠组的血清总蛋白和血红蛋白水平均高于鼻胃组,分别为(64±6)g/L和(61±6)g/L,(120±17)g/L和(106±16)g/L,差异有统计学意义(P<0.05)。(4)鼻肠组较鼻胃组平均ICU住院时间明显缩短,分别为(11±5)d和(14±6)d,两组差异有统计学意义(P<0.05)。(4)两组患者肺部感染、高血糖、腹泻等发生率差异均无统计学意义(P>0.05)。结论经鼻肠管肠内营养支持能更快达到肠内营养支持目标,缩短入住ICU时间。

Objective To investigate the application effect of nasojejunal feeding tube nutrition in patients with severe traumatic brain injury. Methods The clinical data of 54 patients with severe traumatic brain injury admitted to the Department of Surgical Critical Care Medicine,the Third Affiliated Hospital,Sun Yatsen University between June 2012 and December 2014 were analyzed retrospectively. They were divided into either a nasojejunal feeding tube nutrition support group（ nasojejunal group,n = 26） or an asogastric feeding tube nutrition support group（ asogastric group,n = 28） according to the different ways of enteral nutrition. All patients began to receive nasal feeding whole protein preparations（ enteral nutritional emulsion,TPF-D） from the second day after admission to intensive care unit（ ICU）. The time to reach the enteral nutrition support target,the time of parenteral nutritional support,nutritional index（ albumin and hemoglobin）,the time admission to ICU,and the incidences of infection and gastrointestinal complications in both groups were observed. Results（ 1） According to the body weight to calculate calorie demand,the nasojejunal group reaching the time of enteral nutrition support target was faster than that of the asogastric group（ 3. 0 ± 0. 8 d vs. 7. 7 ± 2. 5 d）. There was significant difference between the 2 groups（ P 〈0. 01）. The time of the combined parenteral nutrition support in the nasojejunal group was reduced significantly compared with the asogastric group（ 2. 0 ± 0. 8 d vs. 6. 7 ± 2. 5 d）. There was significant difference between the 2 groups（ P 〈0. 01）.（ 2） At day 30 after treatment,the levels of total serum protein and hemoglobin in the nasojejunal group were higher than those of the asogastric group（ 64 ± 6 g / L vs. 61 ± 6 g / L and 120 ± 17 g / L vs. 106 ±16 g / L,respectively. There were significant differences（ P 〈0. 05）.（ 3） The mean length of stay in the ICU was obviously shorter in nasojejunal group compared with the asogastric group（ 11 ± 5 d vs. 14 ± 6 d）. There was significant difference between the 2 groups（ P 〈0. 05）.（ 4） There were no significant differences in complications of the patients,such as the incidences of pulmonary infection,hyperglycemia,and diarrhea between the 2 groups（ P 〉0. 05）. Conclusion Nasojejunal feeding tube nutrition support may be faster to achieve the target of enteral nutrition supports and shorten the time in ICU.