两种肠外营养治疗方案在重症脑卒中并发低蛋白血症治疗中的疗效比较

目的探讨比较肠内营养联合不同肠外营养治疗重症脑卒中并发低蛋白血症的效果，及对患者早期预后的影响。方法两组患者均于发病48h内给予肠内营养（能全力）；实验组18例患者联合“全合一”肠外营养静脉滴注；对照组给予脂肪乳、氨基酸、人血白蛋白分别静脉滴注；观察两组发病1、3、7、14d血清白蛋白水平及早期预后。结果两组患者血清白蛋白于发病第3天均明显下降；在给予不同的肠外营养方案治疗后，于发病第7天对照组血清白蛋白仍呈进行性下降，实验组则较前略有回升，两组指标相比差异有显著统计学意义（P〈0．01）；于发病第14大两组血清白蛋白水平均较前回升，但两组指标相比差异有统计学意义（P〈0．05）。实验组14d病死率明显低于对照组（P〈0．05）。结论应用“全合一”肠外营养联合肠内营养治疗重症脑华中患者并发低蛋白血症可有效遏制血清白蛋白的进行性下降，降低低蛋门血症所致并发症的发生，改善早期预后。

Effect of two parenteral nutrition supports on hypoproteinemia in patients with severe stroke

Objective To study the effect and the early prognosis of two parenteral nutrition （PN） supports on hypoproteinemia in patients with severe stroke. Methods 35 cases of severe stroke were studied between February 2009 and March 2009 in Beijing Tiantan ttospital. All patients were randomly divided into two groups： experimental group （18 cases） treated with ＂All-In-One＂ parenteral nutrition approach; control group （17 eases） treated with fat milk, amino acids, human serum albumin separately. Serum albumin （ALB） levels and early prognosis were recorded down on the Lst, 3rd, 7th, 14th day after the stroke. Results The ALB level of the two groups was significantly decreased on the 3rd day after the stroke. On the 7th day, the ALB level of the control group continued to be on the progressive decline, while the experimental group rose slightly. There was a significant difference in the ALB level between the two groups （P 〈0.01）. The ALB level of the two groups rebounded on the 14th day, there was a significant difference between the two groups （P 〈0.05）. As compared with the control group, there was a significant lower in mortality during the first 14 days after the stroke in experimental group （P〈0.05）. Conclusion The ＂All-In-One＂ parenteral nutrition support can effectively hold back the progressive decline of ALB in patients with severe stroke. It should be considered the procedure of the treatment on hypoproteinemia in patients with severe stroke.