早期营养制剂与自制匀浆在重型颅脑损伤患者中的应用  

Applications of early nutraceuticals support and homemade homogenate diet in patients with severe traumatic brain injury

作　　者：黄小明 杜宗汉 雷艳 郑丽华[3] 白亚强[4] Huang Xiaoming;Du Zonghan;Lei Yan;Zheng Lihua;Bai Yaqiang(Department of Clinical Nutrition,Nanchong Central Hospital,Nanchong 637000,Sichuan,China;Department of Nutrition and Food Hygiene,College of Public Health,South-west Medical University,Luzhou 646000,Sichuan,China;Department of Clinical Nutrition,No.2 Peoples'Hospital of Yibin,Yibin 644000,Sichuan,China;Department of Neurosurgery,No.2 Peoples'Hospital of Yibin,Yibin 644000,Sichuan,China)

机构地区：[1]南充市中心医院临床营养科,四川南充637000 [2]西南医科大学公共卫生学院营养与食品卫生教研室,四川泸州646000 [3]宜宾市第二人民医院临床营养科,四川宜宾644000 [4]宜宾市第二人民医院神经外科,四川宜宾644000

出　　处：《肿瘤代谢与营养电子杂志》2021年第1期78-81,共4页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：四川省卫生计生委科研课题(18PJ575);泸州市政府—西南医科大学公共卫生学院创新团队项目(SPH18004)。

摘　　要：目的探讨早期营养制剂补充和自制匀浆膳食在重型颅脑损伤(sTBI)患者营养治疗中的应用效果。方法于2018年1月至2019年6月选择宜宾市第二人民医院住院治疗的sTBI患者84例,随机分为营养制剂组和匀浆组,分别给予营养制剂和自制匀浆制剂,4周后观察患者营养相关指标、不良反应/并发症发生情况、格拉斯哥昏迷评分(GCS)及费用情况。结果①营养治疗2周和4周后营养制剂组相关营养指标[血红蛋白、白蛋白、前白蛋白、治疗4周后营养制剂组转铁蛋白、淋巴细胞计数、小腿围和肱三头肌皮褶厚度]高于匀浆组(P<0.05);②营养制剂组患者血糖异常、腹泻和总不良反应/并发症发生率低于匀浆组[血糖异常:(14.3%比35.7%);腹泻:(11.9%比40.5%);总发生率(15.5%比25.0%),P<0.05];③治疗2周和4周后GCS评分营养制剂组显著高于匀浆组[2周:(8.88±1.50)分比(7.76±1.72)分;4周:(10.26±2.40)分比(8.86±2.14)分,P<0.05];④观察期内总住院费用、平均每日住院费用两组患者差异无统计学意义(P>0.05),每日营养治疗费用营养制剂组高于匀浆组[(356.3±43.9)元比(159.4±39.4)元,P<0.05]。结论与自制匀浆制剂相比,营养制剂更有利于改善患者营养状况,降低胰岛素抵抗和腹泻等不良反应的发生率,改善患者预后,其成本‑效果收益可能更好。Objective To discuss the effects of early nutraceuticals support and homemade homogenate diet in patients with severe traumatic brain injury(sTBI).Methods From January 2018 to June 2019,84 sTBI patients were selected from the No.2 peoples′hospital of Yibin and divided into nutraceuticals group and homemade homogenate diet(HDD)group randomly,patients in 2 groups were fed with off⁃the shelf nutraceuticals and HHD respectively,the nutritional indexes,adverse reactions/complications,Glasgow Coma Score(GCS)and hospitalization expenses were observed after 4 weeks.Results①After nutrition support for 2 weeks or 4 weeks,hemoglobin(HB),albumin(ALB),prealbumin(PA),transferrin(TF),lymphocyte count(LYM),calf circumference(CC)and triceps skinfold(TSF)in nutraceuticals group were significantly higher than HHD group(besides TF after nutrition support 2 weeks,P<0.05).②The incidence of pathoglycemia,diarrhea and total adverse reaction/complications in nutraceuticals group was significantly lower than HHD group(pathoglycemia:14.3%:35.7%;diarrhea:11.9%:40.5%;total incidence:15.5%:25.0%,P<0.05).③After nutrition support 2 weeks and 4 weeks,GCS in nutraceuticals groups were significantly higher than HHD group[2 weeks:(8.88±1.50)point(7.76±1.72)point;4 weeks:(10.26±2.40)point(8.86±2.14)point,P<0.05].④There was no difference of total hospitalization expenses and daily hospitalization expenses between 2 groups(P>0.05),daily nutrition support cost in nutraceuticals group was higher than HHD group[(356.3±43.9)yuan(159.4±39.4)yuan,P<0.05].Conclusion Compared with homemade homogenate diet,nutraceuticals support could be more beneficial to promote nutritional status of sTBI patients,reduce the incidence of insulin resistence,diarrhea or other complications,improve the prognosis of sTBI patients with possible better cost⁃effectiveness.

关 键 词：营养制剂 自制匀浆膳食 重型颅脑损伤 营养状况 

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