肠内营养耐受性评分指导重症颅脑创伤患者营养支持治疗的临床效果  

Clinical effect of enteral nutrition tolerance score in guiding nutritional support therapy for patients with severe traumatic brain injury

作　　者：周萍萍[1] 潘慧斌[1] 邹晓月[1] 皇海萍 嵇朝晖[1] ZHOU Pingping;PAN Huibin;ZOU Xiaoyue(Department of Emergency Medicine,The First People's Hospital of Huzhou,Huzhou 313000,China)

机构地区：[1]湖州市第一人民医院急诊科,浙江湖州313000

出　　处：《全科医学临床与教育》2022年第10期902-905,共4页Clinical Education of General Practice

基　　金：浙江省医药卫生科技计划项目(2020RC119、2022PY093)。

摘　　要：目的评价以肠内营养(EN)耐受性评分指导重症颅脑创伤(sTBI)患者营养支持治疗的临床效果。方法选择sTBI患者58例,按照治疗方法不同分为观察组和对照组,对照组患者采用常规的EN管理方案,观察组患者通过以EN耐受性评分为指导的营养支持治疗流程实施EN喂养。比较两组患者7 d内EN实施情况,第7、14天营养指标,以及第7天免疫相关指标的差异。结果与对照组比较,观察组患者7 d内的喂养不耐受中断次数明显减少,平均热卡明显增加,达目标喂养时间明显提前,差异均有统计学意义(Z=5.75,t=2.75,Z=2.92,P均<0.05),两组误吸例数比较,差异无统计学意义(χ^(2)=0.52,P>0.05)。与对照组比较,观察组患者启动EN后第7、14天的血清白蛋白(Alb)、前白蛋白(PA)均明显升高,差异均有统计学意义(t分别=2.50、2.08、2.90、2.91,P均<0.05)。与对照组比较,观察组患者第7天肝素结合蛋白水平、降钙素原(PCT)水平明显降低,差异均有统计学意义(t分别=3.26、2.40,P均<0.05)。结论实施EN耐受性评分指导营养支持治疗的流程能改善sTBI患者的营养效果,增强机体免疫,改善疾病预后。Objective To evaluate the clinical effect of enteral nutrition(EN)tolerance score in guiding nutritional support therapy for patients with severe traumatic brain injury(sTBI).Methods A total of 58 patients with sTBI were di-vided into observation group and control group according to different treatment methods.The control group received routine EN management and observation group received the nutritional support treatment process guided by EN tolerance score.The implementation of EN within 7 days,nutrition indexs on the 7th and 14th day,and immune-related indexes on the 7th day were evaluated in the two groups.Results Compared with the control group,the number of feeding intolerance inter-ruptions within 7 days in the observation group was significantly decreased,the average caloric within 7 days was signifi-cantly increased,and the time of feeding target was significantly earlier(Z=5.75,t=2.75,Z=2.92,P<0.05),the aspiration case within 7 days between the two groups was no significant difference(χ^(2)=0.52,P>0.05).Compared with the control group,the Alb and PA on 7th and 14th day in the observation group were significantly increased(t=2.50,2.08,2.90,2.91,P<0.05).Compared with the control group,the heparin binding protein and PCT on 7th day in the observation group were significantly lower(t=3.26,2.40,P<0.05).Conclusion EN tolerance score guiding the process of nutritional support therapy can improve the nutritional effect of sTBI patients,enhance the body immunity,improve the prognosis of disease.

关 键 词：肠内营养 耐受性评分 重症颅脑创伤 营养效果 

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