早期肠内营养与营养目标策略对TBI老年患者营养状况、炎性因子及预后的改善分析

The Effects of Early Enteral Nutrition and Nutrition Targeting Strategies on Nutritional Status,Inflammatory Factors and Prognosis of Neurosurgical Patients

目的研究早期肠内营养与营养目标策略对神经外科创伤性脑损伤(traumatic brain injuries,TBI)术后老年患者的营养状况、血清炎性因子水平的影响,和对预后的改善作用。方法选取2017年8月至2018年11月于我院神经外科进行手术的年龄>60岁的老年患者为研究对象,共165例,按随机数表法分为目标组和常规组,常规组81例,给予早期肠内营养方法治疗,目标组84例,给予早期肠内营养及营养目标策略方法治疗,比较两组患者的营养状况、血清炎性因子水平、预后情况和并发症情况。结果两组患者营养情况、炎性因子均较治疗前好转,治疗1周后目标组PA(t=9.933,P<0.001)、Alb(t=7.602,P<0.001)、TP(t=19.157,P<0.001)、TRF(t=18.554,P<0.001)、HB(t=2.530,P=0.012)水平均显著高于常规组,CRP、TNF-α、PCT、IL-6、IL-8水平均显著低于常规组(P<0.05),目标组重症监护时间(t=4.590,P<0.001)、住院时间(t=8.298,P<0.001)、90 d再住院率(χ^2=4.568,P=0.033)、治疗1周SOFA评分(t=13.734,P<0.001)、治疗后1月GOS评分(t=8.537,P<0.001),治疗后90 d ADL(t=15.239,P<0.001)均显著优于常规组(P<0.05)。目标组恶心呕吐、感染、腹泻、肝肾功能衰竭等并发症总发生率(9.52%)显著低于常规组(P<0.05)。结论早期肠内营养及营养目标策略可显著改善神经外科术后TBI老年患者的营养状况,降低患者血清炎性因子水平,改善患者预后、减少并发症的发生。

Objective To evaluate the effect of early enteral nutrition and nutrition target strategy on the nutritional status of elderly patients after neurosurgery,as well as the effect on the level of serum inflammatory factor,and the improvement of prognosis.Methods 165 cases who underwent neurosurgery surgery and above 60 years old elderly patients were selected from May,2017 to September,2018 in our hospital.According to the stochastic indicator method,all cases were divided into the target group and routine group:the routine group included 81 patients who received early enteral nutrition,while the target group included 84 patients who received early enteral nutrition and nutrition target strategy.We then compared two groups of patients on nutrition status,the levels of inflammatory factors,prognosis,and complications.Results Both groups of patients’ nutrition situation,inflammatory factors were improved after the treatment.For the target group 1 week after the treatment:PA(t=9.933,P<0.001),Alb(t=7.602,P<0.001),TP(t=19.157,P<0.001),TRF(t=18.554,P<0.001),HB(t=2.530,P=0.012),which were significantly higher than those of the normal group(all P<0.05),while levels of CRP,TNF-α,PCT,IL-6 and IL-8 were significantly lower than those of the routine group(P<0.05).For the targrt group,intensive care time(t=4.590,P<0.001),hospital stay time(t=8.298,P<0.001),90-day readmission rate(χ^2=4.568,P=0.033),SOFA score after 1 week of treatment(t=13.734,P<0.001),GOS after 1 month of treatment(t=8.537,P<0.001),and ADL after 90 days of the treatment(t=15.239,P<0.001)were all significantly better than those of the routine group(P<0.05).Target group’s Nausea,vomiting,infection,diarrhea,liver and kidney failure overall incidence of complications(9.52%)were all significantly lower than those of the routine group(P<0.05).Conclusion Early enteral nutrition and nutrition target strategy can significantly improve the nutritional status of elderly patients after neurosurgery,reduce the level of serum inflammatory factors,shorten the treatment time and hospitalization time in the ICU,reduce the rate of readmission,improve the prognosis and reduce the occurrence of complications.