不同比例肠内营养支持对重型颅脑损伤病人临床结局的影响

Effect of percentage of enteral nutrition in the total energy and nutrition support for patients with traumatic brain injury

目的:探讨不同比例肠内营养支持对重型颅脑损伤病人营养状况、器官功能、并发症发生及病死率的影响。方法:选择2014年9月至2016年6月收治的符合入组标准的94例重型颅脑损伤病人为研究对象。根据EN占联合肠内外营养支持比例,将病人随机分为50%EN组、75%EN组及TEN组(100%EN)。分析各组营养状况指标、血生化指标、并发症发生和治疗效果等情况的差异。结果:营养支持第7天时,50%EN与75%EN组病人的总蛋白、白蛋白水平显著高于TEN组(P<0.05)。75%EN组及TEN组病人的院内感染发生率均低于50%EN组(P<0.05)。75%EN组病人的总住院时间、ICU10天住院费用显著低于其他两组,具有统计学差异(P<0.05)。结论:75%EN比例在肠内外营养支持的应用对重型颅脑损伤病人不但可以提供充足的营养物质,而且能减少感染并发症的发生,缩短ICU住院时间及降低住院费用,在临床应用上具有重要意义。

Objective： This study was conducted to determine the proper percentage of EN in the total energy and nutrition support for critically ill patients with traumatic brain injury（TBIs）. Methods： 94 cases were randomly divided into 3 groups according to the percentage of EN in the total energy： 100% EN group in which patients received 100% calories from EN; 75% EN group in which patients received 75% calories from EN, 25% from PN; 50% EN group in which patients received 50% calories fromm EN, 50% from PN. At baseline and follow-up on day 4, 7, 10, nutrition parameters, complete blood count and electrolytes as well as metabolic parameters including tests of liver and renal function were measured. Complications during treatment were recorded and the prognosis was finally judged. Results： Total protein and albumin were significantly higher in the 50% EN and 75% EN group on day 7 than in TEN group（P〈0.05）. There was significance difference found in complications between 75%EN and 50%EN group. A reduction in the length of stay in the hospital and expenses in the ICU for 10 days in the 75% EN group（P〈0.05）was also observed. Conclusion： 75% calories from EN in the total energy and nutrition support appeared to have great impact on management of critically ill patients with traumatic brain injury.