早期肠内营养支持改善重型颅脑外伤患者胃肠道功能的研究

目的探讨应用预消化型短肽制剂实施早期肠内营养支持（EEN）,对重型颅脑外伤患者胃肠道功能的影响。方法将重型颅脑外伤患者随机分为研究组（n=45）和对照组（n=45）,研究组于入ICU后24～48h开始肠内营养（EN）．予预消化型短肽制剂,对照组于入ICU7d后开始EN。比较两组其入院第1、7、14天的血白蛋白（A）、血前白蛋白（PA）、血红蛋白（Hb）、肱三头肌皮皱厚度（TSF）、上臂周径（AMC）指标变化,并观察两组的胃肠道功能状况。结果入院第7天,研究组各指标较对照组下降缓慢,其中PA两组比较,差异有统计学意义（t=1．67,P〈0．05）,第14天,两组的A、PA、Hb、TSF、AMC指标有所回升,但差异均无统计学意义（t分别=1．29、1．24、0．76、0．68、1．30,P均〉0．05）。研究组较对照组的胃肠道功能障碍（上消化道出血、胃潴留、腹泻、反流）发生率低,两组间的差异有统计学意义（x^2分别=5．87、3．85、4．44、4．11,P均〈0．05）。结论预消化型短肽制剂实施EEN,能改善重型颅脑外伤患者的胃肠道功能。

Effects of early enteral nutrition support on gastrointestinal function in patents with severe craniocerebral trauma

Objective To explore the effects of early enteral nutrition （EEN） support, predigestion oligopeptide, on gastrointestinal dysfunction in patients with severe craniocerebral trauma. Methods Patients with severe craniocerebral trauma were divided into two groups, control group （n=45） and study group （n=45）. The patients in study group received enteral nutrition （EN）, predigestion oligopeptide, 24-48 hours after admission to ICU. The patients in control group received EN support 7 days after admission to ICU, and the following nutrition support program was same as the study group. Albumin （A）, prealbumin（PA）, hemoglobin（Hb）, triceps brachii muscle crease thickness （TSF）, and upper arm perimeter（AMC） were examined at 1, 7, and 14 days after admission. Additionally, the gastrointestinal dysfunction, such as upper digestive tract bleeding, gastric retention, diarrhea, and refluxing were observed. Results At the 7 days, A, PA, Hb, TSF, and AMC decreased slowly, and there was significant difference in PA（t=-1.67,P〈0.05）. At the 14 days, A, PA, Hb, TSF, and AMC increased. However, there were no significant differences between two groups （t=-1.29, 1.24, 0.76, 0.68, 1.30, P〉0.05）. The incidence rates of gastrointestinal dysfunction, such as upper digestive tract bleeding, gastric retention, diarrhea, refluxing, were lower in study group than that of control group, and the differences were significant （x^2=5.87, 3.85, 4.44, 4.11, P〈0.05）. Conclusions EEN support by predigestion oligopeptide can improve the gastrointestinal function of patients with severe craniocerebral trauma.