重症颅脑损伤患者术后早期营养策略探讨  

Early nutrition managements in postoperative patients with severe traumatic brain injury

作　　者：张牡霞[1] 闵锐 刘晴 江丽 ZHANG Mu-xia;MIN Rui;LIU Qing(Department of Neurosurgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院神经外科,330006

出　　处：《中国实用医药》2024年第1期147-150,共4页China Practical Medicine

摘　　要：目的探讨不同营养支持方式对重症颅脑损伤患者术后营养状况、并发症及预后的影响。方法72例入院当日完成手术治疗的重症颅脑损伤患者,根据院区的不同分为试验组(东湖院区)与对照组(象湖院区),每组36例。试验组实施肠内序贯喂养+肠外营养方案,对照组实施全肠内营养方案。比较两组患者的营养指标[血清总蛋白(TP)、血清白蛋白(ALB)和血红蛋白(Hb)]、三头肌皮褶厚度(TSF)、并发症(腹泻、呕吐)发生情况及预后指标[简化急性生理学评分系统Ⅱ(SAPSⅡ)评分]。结果试验组Hb水平为(97.33±7.91)g/L,高于对照组的(89.94±6.17)g/L,差异具有统计学意义(P<0.05)。两组ALB、TP、TSF水平比较,差异无统计学意义(P>0.05)。试验组腹泻发生率80.56%高于对照组的38.89%,腹内压(26.13±4.38)cm H2O(1 cm H2O=0.098 kPa)、SAPSⅡ评分(45.28±3.54)分低于对照组的(30.13±3.91)cm H2O、(55.78±10.16)分,差异有统计学意义(P<0.05);两组呕吐发生率比较,差异无统计学意义(P>0.05)。结论虽然两种营养方案在营养指标上无明显差别,但是肠内序贯喂养结合肠外营养可以改善患者预后。因此,在重症颅脑损伤患者术后管理上,肠内序贯喂养结合肠外营养治疗优于单一的全肠内营养治疗。Objective To investigate the effects of different nutritional support methods on nutritional status,and complications,and prognosis of postoperative patients with severe traumatic brain injury.Methods 72 patients with severe traumatic brain injury were divided into an experimental group(Donghu Branch Hospital)and control group(Xianghu Branch Hospital)by different branch hospitals,with 36 cases in each group.The experimental group received sequential enteral feeding and parenteral nutrition,and the control group received total enteral nutrition.Comparison was made on nutritional indicators[serum total protein(TP),serum albumin(ALB)and hemoglobin(Hb)],triceps skin fold(TSF),the occurrence of complications(diarrhea and vomiting)and prognotic indexes[Simplified Acute Physiology ScoreⅡ(SAPSⅡ)score]between the two groups.Results Hb level in the experimental group was(97.33±7.91)g/L,which was higher than that of(89.94±6.17)g/L in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the levels of ALB,TP and TSF between the two groups(P>0.05).The incidence of diarrhea of 80.56%in the experimental group was higher than that of 38.89%in the control group;the intra-abdominal pressure of(26.13±4.38)cm H2O(1 cm H2O=0.098 kPa)and SAPSⅡscore of(45.28±3.54)points in the experimental group were lower than those of(30.13±3.91)cm H2O and(55.78±10.16)points in the control group.The difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of vomiting between the two groups(P>0.05).Conclusion There is no significant difference in nutritional indicators between the two nutritional regimens,however sequential enteral feeding combined with parenteral nutrition can improve the prognosis of patients.Therefore,in the nutrition management of postoperative patients,sequential enteral feeding combined with parenteral nutrition therapy is superior to total enteral nutrition therapy alone.

关 键 词：重症颅脑损伤 肠内营养 肠外营养 并发症 预后 

分 类 号：R651.15[医药卫生—外科学]