超早期肠内营养支持对中青年脑出血术后患者预后的影响  

Impact of ultra-early enteral nutrition support on the prognosis of young and middle-aged postoperative patients with cerebral hemorrhage

作　　者：白丽丽 冯庆国[1] 滕洪云 郭丽艳 王丹清 张远征 Bai Lili;Feng Qingguo;Teng Hongyun;Guo Liyan;Wang Dangqing;Zhang Yuanzheng(Intensive Care Unit,Tianjin Fifth Central Hospital,Tianjin 300450,China;Neurological Intensive Care Unit,Tianjin Fifth Central Hospital,Tianjin 300450,China;Department of Emergency,Tianjin Fifth Central Hospital,Tianjin 300450,China)

机构地区：[1]天津市第五中心医院重症医学科,天津300450 [2]天津市第五中心医院神经重症科,天津300450 [3]天津市第五中心医院急诊医学科,天津300450

出　　处：《中华危重病急救医学》2024年第9期985-988,共4页Chinese Critical Care Medicine

基　　金：天津市卫生健康科技项目(TJWJ2022QN102)。

摘　　要：目的探讨超早期肠内营养(UEEN)支持对中青年脑出血术后患者预后的影响。方法回顾性分析2020年1月至2023年6月天津市第五中心医院收治的中青年(年龄18~59周岁)脑出血术后患者的临床资料,记录患者一般资料、营养指标、胃肠道并发症、神经功能恢复情况及远期预后。按启动肠内营养(EN)支持的时间将患者分为UEEN组(术后12 h内实施EN)和早期肠内营养(EEN)组(术后24~48 h内实施EN)。分析并比较两组患者上述指标的差异。结果共纳入64例中青年脑出血术后患者,其中UEEN组和EEN组各32例。两组患者的性别、年龄、高血压和糖尿病比例、入院格拉斯哥昏迷评分(GCS)、手术方式等一般资料比较差异均无统计学意义。营养指标方面,两组患者入院7 d的血清总蛋白、白蛋白和血红蛋白水平均较入院1 d时下降,较入院3 d时有所升高,且入院7 d时UEEN组上述指标水平均明显高于EEN组〔总蛋白(g/L):63.05±5.79比59.02±6.63,白蛋白(g/L):40.40±5.26比37.66±4.63,血红蛋白(g/L):133.33±12.58比123.80±21.12,均P<0.05〕。胃肠道并发症方面,UEEN组患者入院14 d内应激性溃疡发生率显著低于EEN组〔12.5%(4/32)比31.3%(10/32),P<0.05〕,但两组患者在喂养不耐受症状方面比较差异无统计学意义。神经功能恢复及远期预后方面,两组患者入院14 d的GCS评分和Barthel指数评分均较入院1 d时有所升高,但两组间比较差异无统计学意义;术后6个月,UEEN组的格拉斯哥预后评分(GOS)和Barthel指数评分均显著高于EEN组〔GOS评分(分):3.81±1.06比3.18±1.06,Barthel指数评分(分):60.78±7.24比54.52±5.13,均P<0.05〕。结论UEEN支持能够改善中青年脑出血术后患者的营养水平,减少术后胃肠道并发症的发生,促进神经功能恢复,提高远期预后效果。Objective To investigate the effect of ultra-early enteral nutrition(UEEN)support on the prognosis of young and middle-aged postoperative patients with cerebral hemorrhage.Methods The clinical data of young and middle-aged patients(aged 18-59 years)admitted to Tianjin Fifth Central Hospital from January 2020 to June 2023 after surgery for intracerebral hemorrhage were retrospectively analyzed,and the general data,nutritional indexes,gastrointestinal complications,neurological function recovery and long-term prognosis of the patients were recorded.According to the time of initiation of enteral nutrition(EN)support,patients were divided into UEEN group(EN implementation within 12 hour after surgery)and early enteral nutrition(EEN)group(EN implementation within 24 to 48 hour after surgery).The differences of the above indexes between the two groups were analyzed and compared.Results A total of 64 young and middle-aged postoperative patients with cerebral hemorrhage were enrolled,including 32 cases in the UEEN group and 32 cases in the EEN group.There were no significant differences in gender,age,proportion of hypertension and diabetes,Glasgow coma score(GCS)on admission and surgical methods between the two groups.In terms of nutritional indexes,serum total protein,albumin and hemoglobin levels of patients in both groups on day 7 after admission were lower than those on day 1,and higher than those on day 3,and the above indexes levels in UEEN group were significantly higher than those in EEN group on day 7[total protein(g/L):63.05±5.79 vs.59.02±6.63,albumin(g/L):40.40±5.26 vs.37.66±4.63,hemoglobin(g/L):133.33±12.58 vs.123.80±22.12,all P<0.05].In terms of gastrointestinal complications,the incidence of stress ulcer in the UEEN group within 14 days after admission was significantly lower than that in the EEN group[12.5%(4/32)vs.31.3%(10/32),P<0.05],but there was no statistically significant difference in feeding intolerance symptoms between the two groups.In terms of neurological recovery and long-term prognosis,

关 键 词：脑出血术后 肠内营养 超早期 营养指标 神经功能 中青年 

分 类 号：R651.12[医药卫生—外科学] R459.3[医药卫生—临床医学]