早期肠内营养在重型颅脑损伤合并腹部创伤术后患者的临床应用

Early enteral nutrition in patients with severe traumatic brain injury requiring exploratory abdominal surgery

目的探讨早期肠内营养对重型颅脑损伤合并腹部创伤患者的疗效及对临床结局的影响。方法回顾性分析2016年1月至2020年12月期间收治的104例重型颅脑损伤合并腹部创伤需要紧急剖腹手术患者的临床资料,其中47例患者早期(24〜48 h)给予管饲肠内营养,作为观察组,57例患者延迟(>48 h)给予管饲肠内营养,作为对照组,分别比较两组患者术后第1天、第7天、第14天血红蛋白、白蛋白、前白蛋白、总胆红素、谷丙转氨酶、C反应蛋白、白细胞水平,以及术后感染性并发症及临床结局。结果术后第14天,观察组前白蛋白水平高于对照组,白细胞水平低于对照组,差异具有统计学意义(P=0.020,P=0.013)。观察组住院时间、住院费用少于对照组,差异均有统计学意义(P=0.017、P=0.032)。观察组肺部感染的发生率为10.6%,低于对照组的29.8%,差异有统计学意义(P=0.017)。结论重型颅脑损伤合并腹部创伤患者术后早期肠内营养,能够显著改善患者营养状况,减少肺部感染发生率,并可减少住院时间及住院费用。

Objective To investigate the effect of early enteral nutrition in patients with severe traumatic brain injury requiring exploratory ahdominal surgery.Methods The clinical data of 104 patients with severe traumatic brain injury requiring exploratory abdominal surgery treated in the PLA Army 72th Group Military Hospital from January 2016 to December 2020 were retrospectively analyzed.Among them,47 patients were given early enteral nutrition(24-48 hr)as the observation group,and 57 patients were given delayed enteral nulrilion(>48 hr),as the control group.Ihe levels of hemoglobin,albumin,prealhumin,total bilirubin,alanine transaminase,C-reactive prolein,while blood cells,postoperative infectious complications and clinical outcomes were compared between the two groups on the 1st,7th and 14th days after surgery.Results On the 14th day after operation,the prealbumin level of the observation group was higher than that of the control group,and the leukocyte level of the observation group was lower than that of the control group,with statistical significance(P=0.020,P=0.013).The hospital stay and hospitalization costs of the observation group were lower than those of the control group(P=0.017,P=0.032).The incidence of pulmonary infection in the observation group was 10.6%,which was lower than 29.8% in the control group(=0.017).Conclusions Early postoperative enteral nutrition in patients with severe traumatic brain injury requiring exploratory abdominal surgery can significantly improve the nutritional status of patients,reduce the incidence of pulmonary infection,the hospital stay and the hospitalization cost.