早期合理应用胃肠内、外营养对重型颅脑损伤预后的作用

The effect of early enteral and parenteral nutrition on the prognosis of severe traumatic brain injury

目的探讨重型颅脑损伤治疗中合理应用胃肠内、外营养支持对其预后的影响。方法将经临床证实的重型颅脑损伤 1 93例中随机抽样出 1 0 8例 ,分成 3组。A组 :单纯胃肠外营养 ;B组 :传统胃肠内、外营养 ;C组 :早期胃肠内、外营养。对其并发症的发生及预后情况进行评估。结果A组病死率为 69.4% ,B组为 47.2 % ,C组为 1 3 .9% ;结论重型颅脑损伤患者 ,早期 (2 4小时内 )即应施用PN支持 ,伤后 48小时若未出现消化道应激性溃疡出血者 ,可缓慢持续性滴注EN液。若患者的GCS分值达 9分以上 ,肠鸣音恢复正常或 2 4小时胃内残留液总量少于 70 0ml,施行EN支持更为安全。

Objective To study the effect of enteral and parenteral nutrit ion on the prognosis of severe traumatic brain injury. Methods 1 08 cases of severe traumatic brain injury were randomly selected from 193 cases confirmed clinically, which were divided into 3 groups: single parenteral nutrit ion group as group A, traditional enteral and parenteral nutrition group as grou p B, and early enteral and parenteral nutrition group as group C. The complicati ons and prognosis were evaluated. Results The fatality rates wer e 69.4%, 47.2% and 13.9%, respectively, in group A, group B, and group C. Conclusion The severe traumatic brain injury patients should take pare nteral nutrition support at early time(within 24 h), who should receive slowly c ontinuous drip of enteral nutrition if stress ulcer of digestive tract does not occur within 48 h. Enteral nutrition is safer when GCS of the patients scores to 9, bowel sounds get normal or remnant liquid in the stomach is less than 700 ml .