高分级动脉瘤性蛛网膜下腔出血病人早期肠内营养的临床研究

The clinical observation of EEN in patients with poor-grade aneurismal subarachnoid hemorrhage

目的：探讨早期肠内营养（EEN）支持对高分级动脉瘤性蛛网膜下腔出血病人营养指标、炎性因子及预后的影响。方法：将76例高分级动脉瘤性蛛网膜下腔出血病人随机分为EEN组和对照组。EEN组病人在入院24h后给予EN支持；对照组在入院第5～7天后给予EN支持。比较两组病人治疗前后营养指标[血清清蛋白（ALB）、总蛋白（TP）、血红蛋白（Hb）、肱三头肌皮皱厚度（TSF）和上臂肌围（AMC）]、炎性因子[白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）]和意识恢复程度的变化。结果：EEN组病人在治疗第7和14天各营养指标水平明显优于对照组（P〈0．05），炎性因子含量较对照组显著降低（P〈0．05），而意识恢复程度（通过GCS评分）好于对照组（P〈0．05）。结论：EEN可有效地改善高分级动脉瘤性蛛网膜下腔出血病人的营养状况，降低炎性因子水平，有利于病人康复。

Objective： To investigate the effect of early enteral nutrition on nutrition condition, inflammatory cytokines and prognostic indicator in patients with poor-grade aneurismal subarachnoid hemorrhage （SAH）. Methods： A total of 76 patients of poor-grade aneurismal subarachnoid hemorrhage were randomly divided into EEN group and control group. The EEN group was fed at 24 hours after admission and the control group was fed at 5 -7 d after admission. The changes of nutritional indicators, the inflammatory cytokines and the GCS score were detected on admission, at 7th day and at 14th day after admission. Results： At the 7th and 14th day, the nutritional indicators in EEN group were significantly higher than that of the control group （ P 〈 0.05 ）. The levels of inflammatory cytokines in the EEN group were significandy lower than those in the control group （P 〈0.05）. The GCS score in EEN group were significantly higher than that of the control group （P 〈 0.05）. Conclusion： The treatment of EEN can effectively improve the nutritional status and reduce the level of inflammatory cytokines, and it may be conducive to the consciousness recovery in patients of poor-grade aneurismal subarachnoid hemorrhage.