早期肠内营养预防重型颅脑损伤病人应激性溃疡的临床研究  

Clinical study on the early enteral nutritional to prevent stress ulcer in severe traumatic brain injury

作　　者：包贇 邱炳辉[1] 李青[2] 曾浩[1] 莫益萍[1] 张南南[1] 漆松涛[1] 

机构地区：[1]南方医科大学南方医院神经外科,广东广州510515 [2]南方医科大学南方医院营养科,广东广州510515

出　　处：《肠外与肠内营养》2016年第3期133-135,142,共4页Parenteral & Enteral Nutrition

基　　金：黎介寿院士肠道屏障专项研究基金

摘　　要：目的:探讨早期肠内营养(EEN)对重型颅脑损伤病人应激性溃疡的预防价值。方法:分析我院85例神经外科重症监护病房收住的重型颅脑损伤病人。将病人分为EEN组和抑酸药组。分析两组病人年龄、性别、GCS评分、水电解质紊乱、凝血功能障碍、高血糖、多发伤、肺部感染、死亡、颅内感染、应激性溃疡及预后等参数。分析抑酸药物的使用与肺部感染发生之间的相关性。结果:EEN组与抑酸药组应激性溃疡的发生无统计学差异(P>0.05);肺部感染发生率有显著性差异(P<0.05)。抑酸药物的使用与肺部感染存在显著的相关性(r=0.253,P=0.019)。两组病人血清前清蛋白、转铁蛋白、上臂周径、预后等方面均有显著性差异(P<0.05)。结论:重型颅脑损伤病人EEN不仅可以预防应激性溃疡的发生,而且还可减少肺部感染的发生率,改善病人的营养状况和预后。Objective： To explore the value of early enteral nutrition in severe traumatic brain injury patients to prevent stress ulcer. Methods： 85 patients with severe traumatic brain injury were analyzed in the neurosurgical ICU of Nangfang Hospital. Patients were divided into 2 groups： the early enteral nutrition group and using antacid group. Age,gender,GCS score,fluid and electrolyte disturbance,coagulation disorder,hyperglycaemia,multiple injuries,pulmonary infection,death,infections of central nervous system,stress ulcers and clinicalprognosis were compared between the two groups. The correlation between antacid therapy and pneumonia was assessed. Results： There was no significant difference in the rate of stress ulcers between two groups. But the incidence of pulmonary infection was significantly different（ P〈0. 05）. Moreover,significant correlation was found between antacid therapy and pulmonary infection（ r = 0. 253,P = 0. 019）. The difference of albumin,prealbumin,transferrin and mid-arm circumference（ P〈0. 05） between the two groups were also significant Conclusion： Early enteral nutrition support may be effective for preventing stress ulcer and pneumonia. Nutritional statements and outcomes were better inearly enteral nutrition group. Early enteral nutrition support is worth further research andclinical application.

关 键 词：重型颅脑损伤 肠内营养 抑酸 肺部感染 应激性溃疡 

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