经鼻胃管与鼻肠管肠内营养对重型创伤性脑损伤患者的治疗效果

Therapeutic effect of nasogastric tube and nasointestinal tube enteral nutrition for severe traumatic brain injury

目的探讨经鼻胃管与鼻肠管肠内营养治疗重型创伤性脑损伤（sTBI）患者的效果。方法采用回顾性病例对照研究分析2013年10月— 2015年12月收治的64例sTBI患者，按随机数字表法分为鼻胃管组和鼻肠管组（管饲相同营养液），每组32例。其中鼻胃管组：男18例，女14例；年龄（37.8±8.7）岁。格拉斯哥昏迷评分（GCS）（4.7±1.3）分。鼻肠管组：男20例，女12例；年龄（39.7±6.5）岁。GCS（4.1±1.2）分。比较两组治疗前和治疗后7，15 d三头肌皮褶厚度、体重指数、血红蛋白、血清白蛋白量、前白蛋白变化及相关并发症发生情况。结果治疗前两组三头肌皮褶厚度、体重指数、血红蛋白、血清白蛋白、前白蛋白差异均无统计学意义（P〉0.05）。治疗后7，15 d鼻肠管组三头肌皮褶厚度、体重指数、血红蛋白、血清白蛋白、前白蛋白均高于鼻胃管组（P〈0.05）；15 d后鼻肠管组肺部感染17例，消化道出血9例，反流性食管炎9例，电解质紊乱11例；鼻胃管组肺部感染7例，消化道出血2例，反流性食管炎1例，电解质紊乱4例。鼻肠管组并发症发生率明显低于鼻胃管组（P〈0.05）。结论与经鼻胃管营养比较，经鼻肠管肠内营养可更好改善sTBI患者的营养状况并降低并发症发生率，值得临床推广。

Objective To investigate the therapeutic effect of enteral nutrition in patients with severe traumatic brain injury （sTBI） by nasogastric tube and nasointestinal tube. Methods A retrospective case control study was made on 64 patients with sTBI hospitalized from October 2013 to December 2015. The patients were assigned to nasogastric tube group （ n = 32 ） and nasointestinal tube group （ n = 32） according to the random number table, and the same nutrient solution was given to all patients. Eighteen male and 14 female patients aged （37.8 ± 8.7）years were identified in nasogastrie tube group, and the Glasgow coma score （GCS） was （4.7± 1.3）points. Twenty males and 14 females aged （39. 7 ±6. 5 ）years were identified in nasointestinal tube group, and the GCS was （4. 1± 1.2） points. Triceps skinfold thickness, body mass index, hemoglobin, level of serum albumin and level of prealbumin were measured and compared between groups before and after operation. Incidence of complications was recorded as well. Results All the above-mentioned indexes of the two groups did not differ significantly before the therapy （P 〉0.05 ） , but showed significant differences 7 and 15 days after therapy （P 〈 0. 05 ）. Incidence of complications in nasointestinal tube group （17 lung infection, nine gastrointestinal bleeding, 11 electrolyte imbalance） was lower than that in nasogastric tube group （ seven lung infection, two gastrointestinal bleeding, one reflux esophagitis, four electrolyte imbalance） （P 〈 0. 05）. Conclusion Nasointestinal tube enteral nutrition is better than nasogastric tube enteral nutrition in improving nutritional status and reducing complications in patients with sTBI.