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目的:观察不同营养方式对重型颅脑损伤病人并发症和预后的影响。方法:将65例重型颅脑损伤病人随机分为早期肠内营养(EEN)组(A组,n=32)和肠外营养(PN)联合EN组(B组,n=33)。A组病人伤后24 h给予EN支持;B组24 h给予PN联合EN支持,PN和EN各提供50%热量。观察两组病人肺部感染发生率、ICU入住时间、呼吸机使用天数和30 d病死率等临床指标。在EN支持期间,观察病人有无腹泻、便秘、恶心、呕吐以和误吸等不良反应。并于病人入院时、入院后第3、7、14天检测血清清蛋白(ALB)、前清蛋白(PA)和血红蛋白(Hb)等营养指标。结果:入院第14天,两组病人血清ALB、PA和Hb接近正常,组间比较无显著性差异(P>0.05);而B组病人的肺部感染发生率、ICU留置时间、呼吸机使用天数均好于A组(P<0.05),两组30 d病死率无显著性差异(P>0.05)。B组病人的不良反应发生率均少于A组(P<0.05)。结论:重型颅脑损伤病人EEN可以改善病人的营养状况,但EN联合PN可有效地保证病人在营养供给的前提下,减少并发症的发生率。
Objective: To observe the effect of different nutritional methods on the complication and prognosis of patients with severe craniocerebral injury. Methods: Sixty-five patients with severe craniocerebral injury were randomly divided into EEN group (group A, n = 32) and parenteral nutrition group (PN group B) (n = 33). Patients in group A were given EN support at 24 hours after injury. Group B received PN combined with EN support at 24 hours, and PN and EN each provided 50% of the calories. The incidences of pulmonary infection, ICU admission time, days of ventilator use and 30-day mortality were observed in two groups of patients. During EN support, observe whether the patient has diarrhea, constipation, nausea, vomiting and aspiration and other adverse reactions. Serum albumin (ALB), pre-albumin (PA) and hemoglobin (Hb) were detected on the 3rd, 7th and 14th day after admission. Results: On the 14th day after admission, the serum ALB, PA and Hb in both groups were close to normal with no significant difference between the two groups (P> 0.05); while the incidence of pulmonary infection, ICU indwelling time, ventilator use Days were better than those in group A (P <0.05). There was no significant difference in the 30-day mortality between the two groups (P> 0.05). Adverse reactions in group B were less than those in group A (P <0.05). Conclusion: EEN in patients with severe craniocerebral injury can improve the nutritional status of patients. However, EN combined with PN can effectively reduce the incidence of complications under the condition of nutritional supply.