早期营养支持在神经外科昏迷患者中的疗效观察

Clinical Observation of Early Nutrition Support in Neurosurgical Coma Patients

目的:研究早期肠外(parenteral nutrition,PN)与肠内营养(enteral nutrition,EN)联合营养支持在神经外科昏迷患者中的疗效。方法:随机选取80例于2016年1-12月在笔者所在医院神经外科监护病房住院的昏迷患者,并随机分为观察组和对照组两组,每组40例,其中观察组采用早期PN+EN营养支持,对照组采用全肠内营养(total enteral nutritional,TEN)支持。分别于营养支持治疗前及营养支持治疗后第1、2周监测总淋巴细胞计数(TLC)、血红蛋白(HGB)、血清白蛋白(ALB)、前白蛋白(PA)等数值。比较两组腹胀、腹泻、吸入性肺炎、应激性溃疡、肝功能异常等并发症。结果:营养支持治疗1周后,观察组HGB、PA较对照组明显高(P<0.05)。营养支持治疗2周后,观察组TLC、ALB较对照组明显高(P<0.05),且观察组的吸入性肺炎、腹胀、腹泻发生率明显低于对照组(P<0.05)。结论:昏迷患者均存在营养风险,需要早期营养支持治疗,与全肠内营养治疗相比,早期肠外+肠内营养治疗可明显提高昏迷患者的营养状况,减少并发症的发生。

Objective：To investigate the clinical efficacy of early parenteral and enteral nutrition support in neurosurgical coma patients.Method：From January 2016 to December 2016,80 coma patients in intensive care unit of neurosurgery in my hospital were randomly selected,and randomly divided into the observation group and the control group,the observation group was given early parenteral and enteral nutrition,the control group received enteral nutrition.The levels of total lymphocyte count（TLC）,hemoglobin（HGB）,serum albumin（ALB）,prealbumin（PA） in two groups before nutritional support and the first,the second week after were observed.The incidence of abdominal distension,diarrhea,aspiration pneumonitis,stress ulcer,liver dysfunction were also compared between the two groups.Result：Compared with the control group,the levels of HGB and PA in the observation group after 1 week of nutritional support were significantly increased（P0.05）.After 2 weeks of nutritional support,TLC,ALB in the observation group were significantly increased（P0.05）,and the incidence of aspiration pneumonitis,abdominal distension,diarrhea in the observation group were significantly lower than those in the control group（P0.05）.Conclusion：These coma patients all have nutritional risk,they need early nutritional support.Compares with only using total enteral nutrition,early parenteral and enteral nutrition support may obviously improve the nutritional status of neurosurgical coma patients and reduce the occurrence of complications.