不同营养支持方式对重型颅脑损伤病人预后的影响  

Effects of different nourishment methods on the patients with traumatic brain injury

作　　者：过群[1] 高伟[1] 张家留[1] 张蓓蓓[1] 殷丽萍[1] 周丹丹[1] 陈浩[1] 

机构地区：[1]江苏省中西医结合医院重症医学科,江苏南京210028

出　　处：《肠外与肠内营养》2014年第4期226-227,232,共3页Parenteral & Enteral Nutrition

摘　　要：目的:观察不同营养方式对重型颅脑损伤病人并发症和预后的影响。方法:将65例重型颅脑损伤病人随机分为早期肠内营养(EEN)组(A组,n=32)和肠外营养(PN)联合EN组(B组,n=33)。A组病人伤后24 h给予EN支持;B组24 h给予PN联合EN支持,PN和EN各提供50%热量。观察两组病人肺部感染发生率、ICU入住时间、呼吸机使用天数和30 d病死率等临床指标。在EN支持期间,观察病人有无腹泻、便秘、恶心、呕吐以和误吸等不良反应。并于病人入院时、入院后第3、7、14天检测血清清蛋白(ALB)、前清蛋白(PA)和血红蛋白(Hb)等营养指标。结果:入院第14天,两组病人血清ALB、PA和Hb接近正常,组间比较无显著性差异(P>0.05);而B组病人的肺部感染发生率、ICU留置时间、呼吸机使用天数均好于A组(P<0.05),两组30 d病死率无显著性差异(P>0.05)。B组病人的不良反应发生率均少于A组(P<0.05)。结论:重型颅脑损伤病人EEN可以改善病人的营养状况,但EN联合PN可有效地保证病人在营养供给的前提下,减少并发症的发生率。Objective：To investigate whether early enteral （EN） or parenteral nutrition （PN） integrated EN may differ in protein/calorie supply,gastrointestinal complication,and outcome in patients with traumatic brain injury （TBI）.Methods：65 patients with TBI were randomized to receive isocaloric and isonitrogenous either EN （A group,n =32） or PN integrated EN （B group,n =33）.The serum levels of ALB,PA,and Hb were measured on the third day,seventh day and fourteenth day.Clinical endpoints as incidence of pulmonary infection,length of stay in ICU and using ventilator,and 30 days mortality were also compared.Results：On the fourteenth day the nitrogen balance of two groups reached the normal level without difference.However,the incidence of pulmonary infection,length of stay in ICU and using ventilator,and gastrointestinal complication in B group were significantly better than those in A group（P ＜ 0.05）.There was no difference in 30 days mortality between the two groups（P ＞ O.05）.Conclusion：The two routes of nutritional support can supply the nutrients to brain injttred patients.PN integrated EN can decrease the incidence of pulmonary infection and gastrointestinal complication.

关 键 词：肠内营养 肠外营养 重型颅脑损伤 预后 

分 类 号：R459.3[医药卫生—治疗学] R651.15[医药卫生—临床医学]