早期肠内营养和延期肠内营养对重型颅脑外伤患者术后营养状况和并发症的影响  

Effects of Early Enteral Nutrition and Delayed Enteral Nutrition on Nutritional Status and Complications in Patients with Severe Traumatic Brain Injury after Operation

作　　者：周燕[1] 卫妙蓉[1] 陈佳 马蓉[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,上海200127

出　　处：《解放军护理杂志》2017年第21期16-19,共4页Nursing Journal of Chinese People's Liberation Army

摘　　要：目的探讨早期肠内营养和延期肠内营养对重型颅脑外伤患者术后营养状况和并发症的影响。方法 2014年6月至2016年6月,便利抽样法选取在仁济医院神经外科监护室(intensive care unit,ICU)治疗的重型颅脑外伤患者80例为研究对象。按入院先后将其分为早期肠内营养组(40例)和延期肠内营养组(40例)。早期肠内营养组患者于术后24~48h开始肠内营养,而延期肠内营养组于术后48h至5d开始肠内营养。记录患者住院期间的相关数据,包括入院当天、肠内营养开始后14d时的白蛋白、前白蛋白、血红蛋白浓度,发症发生情况,比较两组患者入住ICU的时间和出院时格拉斯哥预后评分(Glasgow outcome scale,GOS)。结果在开始肠内营养后第14天,早期肠内营养组患者的白蛋白、前白蛋白、血红蛋白水平均高于延期肠内营养组患者,且腹泻、肺部感染、电解质紊乱的发生率明显低于延期肠内营养患者,且住院时间短于延期肠内营养患者,出院时GOS高于延期肠内营养患者,差异均统计学意义(均P<0.05)。结论早期肠内营养能够有效、及时改善重型颅脑外伤患者的营养状况,纠正患者低蛋白血症;同时还能降低腹泻、肺部感染、电解质紊乱等并发症的发生率,缩短患者ICU住院时间,改善患者预后。Objective To investigate the effects of early enteral nutrition and delayed enteral nutrition on nutritional status and complications after operation in patients with severe traumatic brain injury.Methods By convenience sampling, 80 patients with severe traumatic brain injury were selected and randomly assigned to early enteral nutrition group （n=40） and delayed enteral nutrition group （n=40）. In the early enteral nutrition group,the enteral nutrition was started at 24 -48 hours after operation, and the enteral nutrition in the delayed enteral nutrition group was started at 48 hours --5 days after operation. The relevant data were recorded during hospitalization including the albumin, prealbumin and hemoglobin on the day of admission and 14th day after enteral nutrition,and the incidence of complications. The Glasgow outcome scale （GOS） on the day of admission to ICU and the day of discharge were compared.Results Compared to delayed enteral nutrition group, In early enteral nutrition group, the albumin, prealbumin and hemoglobin levels on the 14th day after enteral nutrition were higher,the incidence of diarrhea,lung infec- tion and electrolyte disorder were lower, the ICU hospitalization time was shorter, the GOS score at dis- charge was higher（all P〈0.05）. Conclusion Early enteral nutrition can improve the nutritional status and remedy the hypoproteinemia of the patients with severe traumatic brain injury effectively and timely. Meanwhile early enteral nutrition can reduce the incidence of diarrhea,lung infection and electrolyte disor- ders, shorten the ICU hospitalization time,and improve the prognosis of the patients.

关 键 词：早期肠内营养 延期肠内营养 重型颅脑外伤 营养状况 并发症 

分 类 号：R651.15[医药卫生—外科学]