早期肠内营养中添加益生菌对重型颅脑损伤患者胃肠动力障碍和营养状况的影响  

Effect of early enteral nutrition with probiotics on gastrointestinal motility disturbance and nutri- tional status of patients with severe craniocerebral trauma

作　　者：周已焰[1] 熊小伟[1] 董荔[2] 高英丽[4] 高英 陈英 朱京慈[1] 

机构地区：[1]第三军医大学护理学院护理基础学教研室,重庆400038 [2]重庆市急救医疗中心护理部 [3]神经外科 [4]泰山医学院护理学院护理学基础教研室

出　　处：《中华创伤杂志》2013年第4期320-324,共5页Chinese Journal of Trauma

基　　金：重庆市卫生局医学科研面上课题资助项目（2011-2-383）

摘　　要：目的观察早期肠内营养中添加益生菌对重型颅脑损伤患者胃肠动力障碍和营养状况的影响。方法选取重型颅脑损伤患者40例，按随机数字表法将患者分为试验组（18例）和对照组（22例），两组患者均在入院后24～72h内经鼻胃管开始肠内营养，试验组在肠内营养基础上添加益生菌。观察整个试验期间患者腹胀、呕吐、反流、胃潴留、便秘、腹泻的发生率，首次排便时间及达肠内营养目标量时间。检测营养开始第0，4，7，15天血清前白蛋白、转铁蛋白等营养指标，并比较住ICU时间。结果两组患者腹胀、呕吐、胃潴留、腹泻差异均无统计学意义，试验组发生反流、便秘例数少于对照组（P〈0．05）。首次排便时间及达肠内营养目标量时间提前于对照组（P〈0．05）。两组前白蛋白、转铁蛋白水平在营养第0，4，7天差异均无统计学意义，在营养第15天试验组前白蛋白、转铁蛋白水平均高于对照组（P〈0．05）。两组住ICU时间差异无统计学意义。结论与单纯肠内营养比较，添加益生菌的肠内营养能改善重型颅脑损伤患者胃肠动力障碍，促进肠内营养顺利实施，从而提高机体营养状况。Objective To investigate effect of early enteral nutrition supplemented with probiot- ies on gastrointestinal motility disturbance and nutritional status in patients with severe craniocerebral trau- ma. Methods Forty patients with severe craniocerebral trauma were randomized into study group （ 18 patients） and control group （22 patients）. Patients of both groups received enteral nutrition via nasogas- trie tube at 24-72 hours after admission, but the patients of study group were also supplemented with pro- biotics simultaneously. Rate of abdominal distention, vomiting, gastro-oesophageal reflux, gastric reten- tion, constipation and diarrhea were recorded during the whole study. Time to first defecation and time to targeted nutritional goals were also recorded. Prealbumin and transferrin in serum were detected at days 0, 4, 7, and 15 after the beginning of enteral nutrition. Length of ICU stay was compared between groups. Results There were no significant differences of the two groups in terms of rate of abdominal distention, vomiting, gastric retention and diarrhea. However, less gastro-oesophageal reflux or consti- pation patients were observed in study group, as compared with control group （ P 〈 0.05 ）. Time to first defecation and time to targeted nutritional goals were shorter in study group, as compared with control group （ P 〈 0.05 ）. Levels of prealbumin and transferrin had no significant differences between the two groups at days 0, 4, and 7, but study group showed both were higher than control group at day 15 （P〈0.05）. Moreover, length of ICU stay showed no significant difference between the two groups. Conclusions Compared with simple enteral nutrition, early enteral nutrition with probiotics improves gastrointestinal motility, facilitates the delivery of enteral nutrition, and further ameliorates nutritional status in patients with severe craniocerebral trauma.

关 键 词：颅脑损伤 益生元 肠道营养 营养状况 胃肠动力 

分 类 号：R651.1[医药卫生—外科学]