早期高能量密度肠内营养对重型颅脑损伤病人肺部感染的影响

Effect of enteral nutrition of energy-dense nutrition emulsions in the treatment of severe traumatic brain injury

目的:探讨早期应用高能量密度肠内营养(EN)乳剂对重型颅脑损伤病人的临床疗效。方法:选取重症医学科(ICU)收治的重型颅脑损伤病人,根据营养制剂能量密度不同随机分为两组。观察组使用高能量密度EN制剂(能量密度1.5 kcal/mL)鼻饲,对照组采用常规EN制剂(能量密度1.0 kcal/mL组)鼻饲。比较两组病人热卡达标率、并发症发生率及临床结局的差异。结果:治疗一周,观察组热卡达标率显著高于对照组(P <0.05)。并发症方面,两组病人腹泻、腹胀等胃肠道不适并发症发生率组间无统计学意义(P> 0.05),但观察组在ICU期间的院内感染的发生率显著均低于对照组(P <0.05)。两组病人总住院时间、ICU入住时间、住院期间的死亡率均无统计学意义(P> 0.05)。结论:早期应用高能量密度肠内营养乳剂可提高重型颅脑损伤病人的能量供应,减少院内感染的发生率。

Objective: To investigate the clinical curative effect of energy-dense nutrition emulsions in critically ill patients with traumatic brain injury. Methods: Traumatic brain injury patients admitted to the Department of Critical Care Medicine were randomly divided into two groups according to different energy densities enteral nutrition(EN).Patients in the control group were treated with routine EN(energy density 1.0 kcal/mL) by nasal feeding while the patients in the observation group were treated with energy-dense(energy density1.5 kcal/mL) by nasal feeding. The supply of energy, incidence of complications and clinical outcome were compared between the two groups. Results: At one week after treatment, the rates of reaching target calories of the observation group were significantly higher than those in the control group. Regarding the complications, the incidence of gastrointestinal discomfort complications such as diarrhea and abdominal distension were not statistically significant between the two groups. During the ICU stay, the incidence of nosocomial infection in the observation group was significantly lower than that in the control group(P <0.05). There was no significant difference in the total length of hospital stay, length of ICU stay, and mortality during hospitalization between the two groups(P > 0.05). Conclusion: Early use of energy-dense nutrition emulsions can improve the adequate energy of patients with severe craniocerebral injury,and reduce the incidence of nosocomial infection complications.