超早期肠内营养干预对重型颅脑损伤术后病人预后的影响  

Effect of ultra-early enteral nutrition intervention on the prognosis after severe craniocerebral injury surgery

作　　者：王佳 刘秀娟[2] 张红 樊欣娜[1] 陆文琪 郑晓艳 李秀梅[1] 李萍 WANG Jia;LIU Xiu-juan;ZHANG Hong;FAN Xin-na;LU Wen-qi;ZHENG Xiao-yan;LI Xiu-mei;LI Ping(Department of clinical nutrition,the First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China;Department of ICU,the First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China;Department of infectious diseases,the First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China)

机构地区：[1]秦皇岛市第一医院,临床营养科,河北秦皇岛066000 [2]秦皇岛市第一医院,重症医学科,河北秦皇岛066000 [3]秦皇岛市第一医院,感染性疾病科,河北秦皇岛066000

出　　处：《肠外与肠内营养》2024年第6期329-333,共5页Parenteral & Enteral Nutrition

基　　金：秦皇岛市科学技术研究与发展计划(202101A112)。

摘　　要：目的:分析超早期肠内营养干预对重型颅脑损伤术后病人预后的影响。方法:前瞻性选取秦皇岛市第一医院神经外科重型颅脑损伤术后的病人154例,采用随机数表法将病人分为试验组和对照组。两组病人术后均在重症监护病房(ICU)接受治疗,术后6 h内均保留气管插管,且均于术后6 h后将床头抬高。试验组在术后6 h即开始超早期肠内营养支持,对照组则是在术后24 h才予以早期肠内营养支持。在干预前及第7日检测两组病人的总蛋白(TP)、血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PA)、白介素-6(IL-6)、C反应蛋白(CRP),记录胃肠道并发症、院内感染发生率及预后指标。结果:干预7 d后,试验组TP、Hb、ALB、PA明显高于对照组(均P<0.05),IL-6、CRP显著低于对照组(均P<0.05),试验组腹胀、腹泻、呕吐、误吸的发生率与对照组无统计学差异(P>0.05),但院内感染发生率、入住ICU时间、总住院时间及死亡率均低于对照组(P<0.05)。结论:超早期的肠内营养干预可以有效的改善重型颅脑损伤术后病人的营养情况及预后。Objective:To analyze the effect of ultra-early enteral nutrition intervention on the prognosis of patients after severe craniocerebral injury surgery.Methods:A prospective study was conducted with 154 patients who underwent surgery for severe craniocerebral injury at the Neurosurgery Department of Qinhuangdao First Hospital.Patients were randomly divided into an experimental group and a control group using a random number table.Both groups received postoperative care in the Intensive Care Unit(ICU)with tracheal intubation retained within the postoperative 6 hours,and the head of the bed was elevated after 6 hours.The experimental group started ultra-early enteral nutritional support 6 hours after surgery,while the control group began early enteral nutritional support 24 hours after surgery.Total protein(TP),hemoglobin(Hb),albumin(ALB),prealbumin(PA),interleukin-6(IL-6),and C-reactive protein(CRP)were detected before intervention and on the 7th day post-intervention.The incidence of gastrointestinal complications,hospital-acquired infections,and prognostic indicators were recorded.Results:On the 7 days after intervention,TP,Hb,ALB and PA levels in the experimental group were significantly higher than those in the control group(P<0.05),and IL-6 and CRP levels were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence of abdominal distension,diarrhea,vomiting,and aspiration between the two groups(P>0.05).However,the incidence of hospital-acquired infections,ICU stay duration,total hospital stays,and mortality rate were all lower in the experimental group compared to the control group(P<0.05).Conclusion:Ultra-early enteral nutrition intervention can effectively improve the nutritional status and prognosis of patients after severe craniocerebral injury surgery.

关 键 词：超早期肠内营养 重型颅脑损伤 干预 预后 

分 类 号：R651.15[医药卫生—外科学]