重型颅脑损伤患儿营养支持现状及其与临床结局的相关性

Current status of nutritional support and its relationship with clinical outcomes in children with severe traumatic brain injury

目的 了解重型颅脑损伤患儿营养支持情况,探讨营养支持与临床结局之间的关系.方法 选取2016年4月至2017年7月收入南京医科大学附属儿童医院外科重症监护室（SICU）的重型颅脑损伤患儿60例,收集患儿性别、年龄、身高、体重、诊断、格拉斯哥昏迷指数评分等一般资料.根据患儿重症监护期间实际能量摄入是否达到目标推荐量,分为能量达标组和未达标组,观察比较两组住院期间的营养支持情况（营养支持开始时间、营养支持方式及途径、肠内营养中断情况、目标能量预测值以及实际能量供给量）、感染性并发症发生情况、机械通气时间、重症监护时间、住院时间、住院总费用以及预后等资料.结果 重型颅脑损伤患儿60例,其中车祸伤37例（61.6％）,高空坠落伤16例（26.7％）、其他原因7例（11.7％）.重症监护室住院时间平均（13.3±8.0）d.SICU期间实际能量摄入达到预测目标能量值共22例（36.7％）,未达到预测目标值38例（63.3％）.两组间实际供能比比较差异有统计学意义（126％比65％,P=0.000）.能量供给达标组与未达标组相比,能量达标组患儿年龄相对较小,两组年龄差异有统计学意义[（3.5±2.8）岁比（6.2±3.9）岁,P=0.006].机械通气时间未达标组明显比达标组长,差异有统计学意义[（2.7±3.9）d比（6.8±11.8）d,P=0.014],未达标组机械通气率明显高于达标组（18.2％比55.3％,P=0.006）.总住院时间能量达标组明显短于未达标组[（16.8±7.7）d比（19.5±11.6）d,P=0.038],总住院费用未达标组较达标组多[（5.4±4.1）万元比（7.6±5.9）万元,P=0.024）].应激性溃疡发生率、感染发生率、重症监护时间两组比较差异无统计学意义.结论 重型颅脑损伤患儿重症监护期间大多数能量摄入不能达到目标推荐量.充足的能量供给可缩短患儿重症监护时间及住院时间,并可降低住院费用.

Objective To investigate the current status of nutritional support in the children with severe traumatic brain injury （TBI）,and the influence of nutritional support on the clinical outcomes.Methods A total of 60 children with severe TBI who were admitted to the surgical intensive care unit （SICU） of our hospital from April 2016 to July 2017 were enrolled in this study.The clinical data like gender,age,height,weight,diagnosis and Glasgow coma scale were collected.The children were divided into two groups by actual energy intake：target energy achieved group and unachieved group.Nutritional support indexes including the start time and the way of nutritional support,interruption of enteral nutritional support,predicted target energy value and actual energy intake,incidence of infectious complications,duration of mechanical ventilation,length of SICU stay,length of total hospital stay,total hospital expenses and prognosis were compared between the two groups.Results Among 60 children recruited,37 （61.6%） were caused by traffic accident,16 （26.7%） were caused by falling,7 （11.7%） by other causes.The average duration of SICU were （13.3± 8.0） days.22 （36.7%） children achieved the target energy,while 38 （63.3%） failed,and the percentage of actual energy supply was 126% and 65%,respectively （P=0.000）.The average age of the target achieved group was younger than that of the target unachieved group [（3.5±2.8） years vs.（6.2±3.9） years,P=0.006],while the duration of the mechanical ventilation was shorter [（2.7±3.9） days vs.（6.8± 11.8） days,P=0.014],and the length of hospital stay was shorter [（16.8±7.7） days vs.（19.5±11.6） days,P=0.038].The total hospital expenses of the target achieved group were lower than the unachieved group [（5.4±4.1） × 10^4 yuan vs.（7.6±5.9） ×10^4 yuan,P=0.024] Conclusions The actual energy intakes of most severe TBI children are less than their target energy.Sufficient energy supply can shorten the length of SICU and hospital stay,and reduce the total hospital expenses.