经皮内镜下胃造瘘术营养支持治疗对重型颅脑损伤患者早期预后的影响  

Effect of enteral nutrition supplied by early percutaneous endoscopic gastrostomy on prognoses in the patients with severe traumatic brain injury

作　　者：李世军[1] 冯金周[1] 刘齐东[1] 刘发健[1] 

机构地区：[1]四川省人民医院神经外科,成都610110

出　　处：《中国临床神经外科杂志》2015年第2期93-95,共3页Chinese Journal of Clinical Neurosurgery

基　　金：四川省卫生厅基金项目资助(100541;110212)

摘　　要：目的探讨经皮内镜下胃造瘘术（PEG）营养支持治疗对重型颅脑损伤（TBI）患者早期预后的影响。方法前瞻性收集重型TBI患者124例,随机分为观察组（63例）和对照组（61例）。所有病人均予以TBI常规治疗,在入院后3 d且病情相对稳定时,观察组病人置PEG管,对照组置胃管,进行营养支持治疗至少2周;除喂养途径有差异外,摄入热量、氮量和其他基础治疗均相同。监测营养治疗期间病人胃肠功能变化、并发症及治疗后1、14、28 d血清白蛋白（ALB）、血红蛋白（Hb）、氮平衡（NB）变化,治疗后1个月,按GOS评分评估患者早期预后。结果营养支持治疗后1、14、28 d,两组患者血清ALB、Hb、NB比较无统计学差异（P〉0.05）。观察组营养液返流发生率（17.5%,11/63）和肺部感染发生率（19.0%,12/63）均明显低于对照组[分别为44.3%（27/61）和37.7%（23/61）;P〈0.05]。治疗后1个月,观察组恢复良好率（GOS评分4～5分;50.8%,32/63）明显高于该杂志（31.2%,19/61;P〈0.05）。结论与经鼻胃管途径相比,早期经PEG途径营养支持治疗TBI,可明显降低患者并发症发生率,显著改善患者早期预后。Objective To study the effect of early enteral nutrition supplied by percutaneous endoscopic gastrostomy on theprognoses in the patients with severe traumatic brain injury（s TBI）.MethodsOne hundred and twenty-six patients with s TBI wererandomly divided into two group, i.e. observed group where 63 patients were supplied with enteral nutrition by the percutaneousendoscopic gastrostomy 3 days after s TBI and control group where 61 patients were supplied with nutrtion by nasogastric tube 3 daysafter s TBI. The change in the gastrointestinal function and complications during the enteral nutrition were observed in all the patients.The serum albumin and hemoglobin levels and nitrogen balance were determined 1, 14 and 28 days after the enteral nutrition in all thepatients. The prognoses were assessed by GOS in all the patients.ResultsThere were insignificantly differences in the serum albuminand hemoglobin levels, nitrogen balance and prognoses between both the groups（P0.05）. The rates of occurrences of the gastriccontents return and pneumonia were significantly lower in the observed group than those in the control group（P0.05）.ConclusionTheentral nutrition supplied by early percutaneous endoscopic gastrostomy is helpful to reducing the complications in the patients with TBI.

关 键 词：重型颅脑损伤 肠内营养 经皮内镜下胃造口术 预后 

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