浙江省重型颅脑创伤患者营养支持治疗的现状调查

A cross-sectional study on current status of the nutritional support for patients with severe tratmmtic brain injury in Zhejiang province

目的调查并了解浙江省重型颅脑创伤患者营养支持治疗的现状。方法本研究回顾性纳入浙江省24家医院神经外科2015年10月至2016年11月收治的219例重型颅脑创伤患者，采用填写调查问卷的形式收集患者的病例资料。调查内容包括：患者的基本信息、人院CT检查、伤后的病情变化、营养支持治疗的内容及相关并发症。对所有患者行电话或门诊随访，评估格拉斯哥预后评分（GOS评分）。结果219例患者基本能早期进行营养支持治疗，至伤后第7天，营养给予率为99．1％。营养支持治疗方式多样化，创伤后早期肠内营养的比例较高。创伤后30d内，所有患者的能量给予量占目标量百分比逐渐增加，从（42．8±34．1）％增至（85．5±27．7）％（P〈0．05）；但是能量给予达标率偏低（6．2％～29．1％）。蛋白给予达标率也偏低（12．4％-24．3％），且伤后30d内变化不明显（P〉0．05）。随访至伤后6个月，其中预后良好113例，预后不良89例，17例死亡。预后分析显示，7d内能量给予不达标组的患者伤后6个月预后良好率明显低于能量给予达标组（X^2=8．354，P〈0．05）。营养支持治疗会出现呕吐、腹泻等多种并发症，其中高血糖的发生率最高（0．5％～13．7％）。结论浙江省医疗单位对重型颅脑创伤患者的营养支持治疗虽然能做到早期给予和多样化给予，但却存在能量和蛋白质给予达标率严重偏低的问题。

Objective To study the current status of the nutritional support for patients with severe traumatic brain injury in Zhejiang province. Methods A total of 219 patients in 24 hospitals in Zbejiang province were enrolled from October 2015 to December 2016 in this study. All the clinical information of these patients after arriving at hospital were recorded, as well as the contents and complications of nutritional support after injury. All patients were followed up , and their Glasgow Outcome Scale were evaluated and recorded. Results A majority of patients in this study obtained early nutritional support after the injury, which accounted for 99.06% of all cases on the 7th day post injury. The percentage of enteral nutrition was relatively high. Within 30 days post injury, the average ratio of actual calorie supplementation to the target of calorie supplementation had increased from （42.8 ± 34.1 ） % to （ 85.5 ± 27.7 ） % （ P 〈 0.05 ） . However, the rate of adequate calorie supplementation was as low as 6. 2% -29.1% , and the percentage of adequate calorie and protein supplementation was 12.4% - 24. 3% , which remained relatively unchanged within 30 days post injury （ P 〉 0.05 ）. At 6-month follow-up post injury, good outcomes were achieved in 113 cases, poor outcomes occurred in 89 cases, and 17 cases died. Subgroup analysis indicated that patients with inadequate calorie supplementation within 7 days post injury had poorer outcomes at 6-month follow-up compared with patients with adequate calorie supplementation （X^2 = 8. 354, P 〈 0.05）. Multiple complications such as nausea and vomiting were observed and related to nutritional support, among them the most common form was hyperglycemia with the incidence rate of 0.5% 13.7%. Conclusion Early and diverse nutritional support has been provided for patients with severe traumatic brain injury in Zhejiang province. However, the rate of adequate calorie and protein sunDlementation seems critically low.