早期联合胃肠内、外营养对重型颅脑损伤患者的临床观察

Clinical Observation of Early Combined Enteral and Parenteral Nutrition on Patients with Severe Traumatic Brain Injury

目的研究颅脑损伤治疗中运用胃肠营养支持对髙代谢反应及其预后的影响。方法128例重型颅脑损伤病人中随机选取75例,并按营养支持方式分为甲、乙、丙三个治疗组。监测三组氮平衡和实验室指标,并观察并发症及预后情况。结果伤后7d丙组排氮量明显低于甲、乙组(P<0.05).在伤后14d内三组均表现为负氮平衡,28d时均得到纠正。三组ICr在伤后均显著下降,1、7d差异无统计学意义,而14、28d时丙组ICr显著高于甲、乙组(P<0.05);伤后1d三组血清白蛋白、血红蛋白、外周血淋巴细胞计数及血浆皮质醇差异无统计学意义(P>0.05);7、14d时丙组血清白蛋白、血红蛋白和外周血淋巴细胞计数高于甲、乙组,差异有统计学意义(P<0.05);血浆皮质醇浓度伤后初期均较正常显著升高,并且在7、14、28d时丙组均低于甲、乙组(P<0.05);丙组的并发症及死亡率在4周内均明显低于甲、乙组(P<0.05).结论早期联合胃肠内、外营养可以使严重脑外伤患者获得较多的热能和蛋白质,改善氮平衡,加快血清蛋白质的合成,促进创伤组织的修复和神经功能恢复,明显改善预后和降低病死率、致残率。

Objective To evaluate the effects of enteral and parenteral nutr让ion on the higher metabolic reaction and prognosis of severe brain injury. Methods 75 cases of patients with severe brain injury were randomly selected from 128 cases confinned clinically, which were divided into 3 groups according to nutritional support: A, B and C. The nitrogen balance and laboratory indexes of the three groups were monitored, and the complications and prognosis were observed. Results The amount of nitrogen excretion in group C was significantly lower than that in group A and group B on the seventh day after injury (Pc 0.05). Within 14 days after injury, all three groups showed negative nitrogen balance, which was corrected on the twenty-eighth day. The ICr of the three groups decreased significantly after injury, and there was no significant difference on the first and seventh day, while ICr in group C was significantly higher than that in group A and group B on the fourteenth and twenty-eighth day (P < 0.05). There was no significant difference in serum albumin, hemoglobin, peripheral blood lymphocyte count and plasma cortisol between the three groups on the first day after injury (P > 0.05). On the seventh and fourteenth day, serum albumin, hemoglobin and peripheral blood lymphocyte count in group C were significantly higher than those in group A and group B (P< 0.05). The plasma cortisol concentration was significantly higher than normal at the early stage of injury, and was lower in group C than that in group A and group B on the seventh, fourteenth and twenty-eighth day (P < 0.05). The complications and mortality of group C were significantly lower than those of group A and group B within four weeks (P < 0.05). Conclusion Early combined parenteral and enteral nutrition can obtain more heat energy and protein, ameliorate nitrogen balance, accelerate synthesis of serum protein, promote reparation of traumatic tissue and restoration of neural function, significantly improve the prognosis and reduce the mortality and disability rate for patients with serious cerebral injuries.