早期亚低温血液滤过联合肠内营养在重型颅脑损伤患者术后治疗中的效果  

Early mild hypothermia hemofiltration combined with enteral nutrition in the treatment of patients with severe craniocerebral injury

作　　者：洪德全 吴小霞 HONG Dequan;WU Xiaoxia(Nanchang First Hospital,Nanchang 330008,China)

机构地区：[1]南昌市第一医院,江西南昌330008

出　　处：《中国实用神经疾病杂志》2023年第10期1232-1238,共7页Chinese Journal of Practical Nervous Diseases

基　　金：江西省卫生健康委科技计划(编号:20192337)。

摘　　要：目的观察早期亚低温血液滤过联合肠内营养在重型颅脑损伤(SCCI)患者术后治疗中的应用效果。方法采用目的抽样法,选取2020-01—2022-07南昌市第一医院急创中心收治的60例SCCI患者为研究对象,分为观察组和对照组各30例。对照组采取传统治疗方法,观察组在对照组基础上采取早期亚低温血液滤过联合肠内营养治疗,30 d为1个疗程,2组均连续治疗2个疗程。治疗前后分别测定患者细胞因子水平[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)及神经元特异性烯醇化酶(NSE)]。采用超声经颅多普勒血流分析仪测定治疗前后动脉收缩期峰流速(Vs)、平均血流速度(Vm)、搏动指数(PI)及颅内压(ICP)参数。应用中文版格拉斯哥预后量表(GOS)评价患者预后。运用无创血流动力学心功能检测仪监测患者心率(HR)与呼吸频率(RR)指标,血糖仪测定血糖值(MBG)。结果治疗2个疗程后,2组细胞因子水平低于治疗前(P<0.05),且观察组细胞因子水平低于对照组(P<0.05)。治疗2个疗程后,2组Vs与Vm高于治疗前,PI与ICP低于治疗前(P<0.05),且观察组Vs与Vm高于对照组,PI与ICP低于对照组(P<0.05)。治疗2个疗程后,2组预后优于治疗前(P<0.05),且观察组预后优于对照组(P<0.05)。治疗2个疗程后,2组生命体征指标低于治疗前(P<0.05),且观察组生命体征指标低于对照组(P<0.05)。结论早期亚低温血液滤过联合肠内营养治疗可改善SCCI患者脑代谢功能及生命体征,减轻细胞因子水平,提高预后。Objective To investigate the effect of early mild hypothermia hemofiltration combined with en⁃teral nutrition in postoperative treatment of patients with severe craniocerebral injury(SCCI).Methods A total of 60 patients with SCCI admitted to the Emergency Innovation Center of Nanchang First Hospital from January 2020 to July 2022 were selected as research objects,and they were divided into observation group and control group with 30 patients in each group.The control group was treated with traditional treatment,and the observation group was treated by early mild hypothermia hemofiltration combined with enteral nutrition on the basis of the con⁃trol group,30 days as a course of treatment,and both groups were treated for two consecutive courses of treatment.Cytokine levels(tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP),and neu⁃ron-specific enolase(NSE))were measured before and after treatment.The peak systolic velocity(Vs),mean blood flow velocity(Vm),pulsation index(PI)and intracranial pressure(ICP)were measured by transcranial Doppler ultrasonography.The Chinese version of Glasgow outcome scale(GOS)was used to evaluate the prognos⁃tic quality before and after treatment.Heart rate(HR)and respiratory rate(RR)were monitored by non-invasive hemodynamic cardiac function detector,and blood glucose value(MBG)was measured by glucose meter.Re⁃sults After 2 courses of treatment,the cytokine level in two groups was lower than before treatment(P<0.05),and the cytokine level in observation group was lower than that in control group(P<0.05).After 2 courses of treat⁃ment,Vs and Vm in two groups were higher than before treatment,PI and ICP were lower than those before treat⁃ment(P<0.05),and in the observation group Vs and Vm were higher than those in the control group,PI and ICP were lower than those in the control group(P<0.05).After 2 courses of treatment,the quality of prognosis in two groups was higher than those before treatment(P<0.05),and the quality of prognosis in the observat

关 键 词：重型颅脑损伤 早期亚低温血液滤过 肠内营养 细胞因子 脑代谢功能 

分 类 号：R651.15[医药卫生—外科学]