不同肠内营养方式对重型颅脑损伤患者代谢及预后的影响  

Clinical study of different enteral nutrition methods on metabolism and prognosis of patients with severe traumatic brain injury

作　　者：廖利萍[1] 高英[2] 何琦 陈鹏 王科[1] 陈英[1] 邓永兵[1] Liao Liping;Gao Ying;He Qi;Chen Peng;Wang Ke;Chen Ying;Deng Yongbing(Department of Neurosurgery,Chongqing Emergency Medical Center,Chongqing 400014,China;Department of Nursing,Chongqing Emergency Medical Center,Chongqing 400014,China)

机构地区：[1]重庆市急救医疗中心神经外科,重庆400014 [2]重庆市急救医疗中心护理部,重庆400014

出　　处：《中国中西医结合急救杂志》2023年第3期343-347,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：重庆市科卫联合医学科研项目(2022MSXM111)。

摘　　要：目的观察两种不同肠内营养方式对重型颅脑损伤(sTBI)患者代谢及预后的影响。方法采用回顾性队列研究方法。选择2021年10月至2022年9月重庆市急救医疗中心神经外科收治的sTBI患者作为研究对象。根据肠内营养方式不同将患者分为观察组(实施经鼻肠管肠内营养)和对照组(实施经鼻胃管肠内营养)。比较两组治疗前和治疗后7 d、14 d营养代谢指标血清前白蛋白(PAB)、白蛋白(Alb)、总蛋白(TP)、D-乳酸水平和免疫功能指标以及腹胀腹泻、血糖紊乱、食管反流误吸、肺部感染、胃潴留等并发症发生率的差异,并观察两组28 d病死率。结果最终85例患者纳入研究,观察组43例,对照组42例。随治疗时间延长,两组治疗后PAB、Alb、TP和免疫球蛋白(IgA、IgG、IgM)均逐渐升高,D-乳酸均逐渐降低,治疗后14 d达到峰值或谷值,且观察组上述指标的变化均明显优于对照组〔PAB(mg/L):253.62±21.13比236.38±18.47,Alb(g/L):55.59±5.14比51.14±4.52,TP(g/L):186.95±24.72比159.84±21.47,D-乳酸(mmol/L):32.16±2.29比46.86±5.11,IgA(g/L):1.90±0.52比1.70±0.50,IgG(g/L):9.62±1.74比8.56±1.70,IgM(g/L):1.18±0.50比1.03±0.41,均P<0.05〕;观察组接受肠内营养干预期间腹胀腹泻、血糖紊乱、肺部感染发生率与对照组比较差异均无统计学意义〔13.95%(6/43)比16.67%(7/42),χ^(2)=0.121,P=0.728;6.98%(3/43)比9.52%(4/42),P=0.713;9.30%(4/43)比14.29%(6/42),P=0.520〕;观察组食管反流误吸、胃潴留发生率均明显低于对照组〔2.33%(1/43)比19.05%(8/42),P=0.015;4.65%(2/43)比23.81%(10/42),χ^(2)=6.432,P=0.011〕。观察组28 d病死率与对照组比较差异无统计学意义〔6.98%(3/43)比11.90%(5/42),P=0.483〕。结论sTBI患者采取鼻肠管方式行肠内营养治疗在改善患者营养代谢、肠黏膜屏障功能、免疫功能,以及减少肠内营养相关并发症方面均明显优于鼻胃管肠内营养。Objective To observe the effects of two different enteral nutrition methods on the metabolism and prognosis of patients with severe traumatic brain injury(sTBI).Methods A retrospective cohort study was conducted,the sTBI patients admitted to the department of neurosurgery of Chongqing Emergency Medical Center from October 2021 to September 2022 as research objects.According to different methods of enteral nutrition,the patients were divided into observation group(receiving enteral nutrition through nasointestinal tube)and control group(receiving enteral nutrition through nasogastric tube).The levels of serum prealbumin(PAB),albumin(Alb),total protein(TP),D-lactic acid and immune function indexes,as well as the incidence of complications such as abdominal distension,and diarrhea,blood sugar disorder,esophageal reflux aspiration,pulmonary infection,gastric retention were compared between the two groups before treatment and 7 days,14 days after treatment,and the 28-day mortality was observed between the two groups.Results A total of 85 patients were enrolled in the study,43 in the observation group and 42 in the control group.With the extension of treatment time,PAB,Alb,TP and immunoglobulin(IgA,IgG,IgM)in the two groups gradually increased after treatment,while D-lactic acid gradually decreased,reaching the peak or valley value 14 days after treatment,and the changes of the above indicators in the observation group were better than those in the control group[PAB(mg/L):253.62±21.13 vs.236.38±18.47,Alb(g/L):55.59±5.14 vs.51.14±4.52,TP(g/L):186.95±24.72 vs.159.84±21.47,D-lactic acid(mmol/L):32.16±2.29 vs.46.86±5.11,IgA(g/L):1.90±0.52 vs.1.70±0.50,IgG(g/L):9.62±1.74 vs.8.56±1.70,IgM(g/L):1.18±0.50 vs.1.03±0.41,all P<0.05].There was no significant difference in the incidence of abdominal distension and diarrhea,blood glucose disorder and pulmonary infection between the observation group and the control group during enteral nutrition intervention[13.95%(6/43)vs.16.67%(7/42),χ^(2)=0.121,P=0.728;6.98%(3/43)v

关 键 词：重型颅脑损伤 鼻胃管肠内营养 鼻肠管肠内营养 营养代谢 预后 

分 类 号：R246.6[医药卫生—针灸推拿学]