超早期肠内营养对ICU重型颅脑损伤患者预后的影响  

Impact of ultra-early enteral nutrition on the prognosis of ICU patients with severe traumatic brain injury

作　　者：徐丙金 卜玮 缪习友 刘杰 邵敏[2] 汤家才 XU Bing-jin;BU Wei;MIAO Xi-you;LIU Jie;SHAO Min;TANG Jia-cai(Department of Critical Care Medicine,People′s Hospital of Laian County,Chuzhou 239200,Anhui,China;不详)

机构地区：[1]安徽省来安县人民医院重症医学科,安徽滁州239200 [2]安徽医科大学第一附属医院重症医学科,安徽合肥230031 [3]安徽省凤阳县人民医院重症医学科,安徽滁州239100 [4]安徽省太和县人民医院重症医学科,安徽阜阳236600

出　　处：《广东医学》2025年第2期238-244,共7页Guangdong Medical Journal

基　　金：合肥综合性国家科学中心大健康研究院健康大数据与群体研究所第二轮科研项目(JKS2023002)。

摘　　要：目的探讨超早期肠内营养是否可以改善重型颅脑损伤(SBI)患者的28 d临床结局。方法本研究收集2022年5—6月安徽省内47家二级甲等以上综合性公立医院入住重症医学科(ICU)重型颅脑损伤患者的临床资料。将入ICU 24 h内启动肠内营养定义为超早期肠内营养,并按照其入ICU后第28天为节点分为生存和死亡两组。比较两组患者入ICU时一般资料、临床评分、实验室检查指标及超早期肠内营养的差异,然后使用二元logistic回归模型筛选出与患者死亡相关的因素,再用Kaplan-Meier法比较<24 h、24~48 h、>48 h启动肠内营养三组患者的28 d生存情况。结果在纳入的285例SBI患者中,死亡组患者86例,生存组199例。两组间年龄、入ICU体温、血氧饱和度、APACHEⅡ评分、SOFA评分、血小板计数、超早期肠内营养差异具有统计学意义(P<0.05)。多因素二元logistic回归分析结果显示超早期启动肠内营养是普通型SBI患者28 d预后的保护性因素(P=0.013)。Kaplan-Meier法结果显示24~48 h启动肠内营养患者的28 d生存率较<24 h者稍大,而<24 h及24~48 h启动肠内营养的SBI患者28 d生存率明显高于>48 h启动肠内营养者,差异有统计学意义(P<0.001)。结论普通型重型颅脑损伤患者超早期肠内营养能够改善患者营养状态,降低患者28 d死亡率。Objective To investigate whether ultra-early enteral nutrition can improve the 28-day clinical outcomes of patients with severe traumatic brain injury(SBI).Methods Clinical data of ICU patients with SBI from 47 public hospitals in Anhui province from May to June 2022 were collected.Patients who started enteral nutrition within 24 hours of ICU admission were classified as receiving ultra-early enteral nutrition.They were then divided into survival and death groups based on their status at 28 days post-admission.Differences in general data,clinical scores,laboratory indicators,and the application of ultra-early enteral nutrition were compared between the groups.A binary logistic regression model was used to identify factors associated with patient mortality,and Kaplan-Meier analysis was performed to compare the 28-day survival rates of patients in the groups of<24 h,24-48 h and>48 h initiated enteral nutrition.Results Among the 285 enrolled SBI patients,86 were in the death group and 199 in the survival group.Significant differences were observed between the groups in terms of age,temperature,oxygen saturation,GCS score,APACHEⅡscore,SOFA score,platelet count,and application of ultra-early enteral nutrition(P<0.05).Multi-factor binary logistic regression analysis indicated that ultra-early enteral nutrition is a protective factor for 28-day prognosis in general SBI patients(P=0.013).Kaplan-Meier results demonstrated that the 28-day survival rates of patients intiated with enteral nutrition for 24 to 48 hours was slightly higher than that of patients initiated with enteral nutrition for 24 to 48 hours,and the 28-day survival rate of SBI patients initiated with enteral nutrition for 24 to 48 hours was significantly higher than that of patients initiated with enteral nutrition for>48 hour with stastistical significunce(P<0.001).Conclusion Ultra-early enteral nutrition can improve the nutritional status and reduce the 28-day mortality rate in patients with severe traumatic brain injury.

关 键 词：重型颅脑损伤 超早期肠内营养 营养支持 预后 

分 类 号：R651.15[医药卫生—外科学] R459.3[医药卫生—临床医学]