重型颅脑创伤合并非腹源性肠梗阻24例临床分析

Clinical analysis on the treatment of 24 cases of severe traumatic brain injury with non ventral intestinal obstruction

目的探讨重型颅脑创伤合并非腹源性肠梗阻临床治疗方法。方法共48例重型颅脑创伤患者中24例合并非腹源性肠梗阻,其中3例(12.50%)行开颅血肿清除术、5例(20.83%)行开颅血肿清除术+去骨瓣减压术、16例(66.67%)予保守治疗,均予胃肠减压和肠外营养支持治疗;24例未合并非腹源性肠梗阻,其中4例(16.67%)行开颅血肿清除术、6例(25%)行开颅血肿清除+去骨瓣减压术、14例(58.33%)予保守治疗,均予肠内营养支持治疗。分别于治疗后10和20 d检测血红蛋白、白蛋白和前白蛋白表达变化。结果与对照组相比,观察组患者血红蛋白(P=0.008)、白蛋白(P=0.002)、前白蛋白(P=0.031)水平均降低;与治疗后10 d相比,治疗后20 d血红蛋白(P=0.003)、白蛋白(P=0.000)、前白蛋白(P=0.005)水平均降低。结论早期诊断并及时治疗重型颅脑创伤合并非腹源性肠梗阻,可以有效缓解肠梗阻症状,有利于早期肠内营养支持,提高患者康复能力。

Objective To discuss the clinical treatment for severe traumatic brain injury （sTBI） with non ventral intestinal obstruction. Methods A total of 48 patients with sTBI were enrolled in this study, including 24 with （observation group） and 24 without （control group） non ventral intestinal obstruction. Among 24 patients with non ventral intestinal obstruction, 3 cases （12.50%） were treated by craniotomy evacuation of hematoma, 5 cases （20.83%） were treated by craniotomy evacuation of hematoma and decompressive craniectomy, and 16 cases （66.67%） were treated by conservative treatment. They were all treated by gastrointestinal decompression and parenteral nutrition. Among 24 patients without non ventral intestinal obstruction, 4 cases （16.67%） were treated by craniotomy evacuation of hematoma, 6 cases （25%） were treated by craniotomy evacuation of hematoma and decompressive craniectomy, and 14 cases （58.33%） were treated by conservative treatment. They were all treated by enteral nutrition. Hemoglobin （Hb）, albumin （ALB） and prealbumin （PA） were detected 10 and 20 d after treatment. Results Compared with control group, the level of Hb （P = 0.008）, ALB （P = 0.002） and PA （P = 0.031） were significantly reduced in observation group. Compared with 10 d after treatment, the level of Hb （P = 0.003）, ALB （P = 0.000） and PA （P = 0.005） were significantly reduced 20 d after treatment. Conclusions Early diagnosis and timely treatment for non ventral intestinal obstruction in patients with severe traumatic brain injury could effectively relieve the symptoms of intestinal obstruction, and is favorable to early enteral nutrition, so as to enhance the patients＇ recovery.