重型颅脑损伤病人肠内营养相关性腹泻规范化处理流程的应用研究

Application of enteral nutrition-related diarrhea standardized management process in patients with severe craniocerebral injury

1冃的:探讨肠内营养(EN)相关性腹泻规范化处理流程在重型颅脑损伤病人中的作用。方法:以医护人员是否接受规范化处理流程培训为时间节点将重型颅脑损伤病人分为对照组(培训前)和观察组(培训后)。两组在入住ICU后24 ~ 48 h内开始EN。对照组在病人出现腹泻后,采用常规方案观察和经验性处理措施。观察组按EN相关性腹泻的原因鉴别与对症处理流程进行处理。比较两组病人的腹泻持续时间与恢复喂养时间、血电解质水平、营养指标、住院天数及30 d死亡率。结果:共84例重型颅脑损伤病人入组,其中对照组和观察组各42例。观察组病人的腹泻持续时间与恢复喂养时间、住院天数、电解质紊乱例数等方面均低于对照组(P<0.05)o观察组的血清总蛋白、白蛋白、转铁蛋白、前白蛋白均高于对照组(P<0.05)。观察组的30 d死亡率、总淋巴细胞计数与对照组的无统计学差异(P > 0.05) o 结论:采用规范化的EN相关性腹泻处理流程能有效改善病人营养状况,提升EN效果,改善其营养指标和预后。

Objective: To investigate the role of enteral nutrition (EN) associated diarrhea standardized management processin patients with severe craniocerebral injury. Methods} Patients with severe craniocerebral injury were divided into control group (before training) and observation group (after training) based on whether the medical staff received training of standardized management process. Both groups began EN within 24 to 48 h after ICU admission. The control group adopted routine observation and empirical treatment after diarrhea. The observation group was treated according to the cause identification and symptomatic treatment procedures of EN -associated diarrhea. The duration of diarrhea and recovery feeding time blood electrolyte levels, nutritional indicators, length of stay and mortality at 30 days were compared between the two groups. Results: A total of 84 patients with severe craniocerebral injury were enrolled into the group, including 42 cases in the control group and 42 cases in the observation group. The duration of diarrhea and recovery feeding time, length of stay in hospital, and number of electrolyte disturbance cases in the observation group were lower than those in the control group (P < 0.05). The serum total protein, albumin, transferrin and prealbumin in the observation group were higher than those in the control group (P < 0.05). There were no statistically significant differences between the observation group and the control group in mortality and total lymphocyte count at 30 days (P > 0.05). Conclusion: Standard procedures for the identification of causes and symptomatic management of EN associated diarrhea can effectively improve the nutritional status of patients, improve the effect of EN, and improve their nutritional indicators and prognosis.