大黄联合肠内营养在重型颅脑伤患者营养支持中的作用观察

目的观察重型颅脑伤患者采用生大黄联合肠内营养支持的效果。方法选择我院ICU中90例重型颅脑伤(GCS<8分)患者随机分为2组各45例。治疗组:入院后早期(24 h内)以生大黄粉3～5 g+30 ml温水胃管内注入,每日2～3次,并给肠内营养混悬液。对照组:入院48 h后给予3 L袋装营养液经中心静脉均匀滴注,营养液量和比例从低量开始,逐渐增加。结果治疗组肠内营养(EN)支持后患者血清白蛋白、血清前白蛋白较支持前明显增高,差异有统计学意义(P<0.05);与对照组支持后比较增高明显,差异有统计学意义(P<0.05);血红蛋白、上臂肌围、肱三头肌皮皱厚度较EN支持前略有增高,但差异无统计学意义(P>0.05)。对照组肠外营养(PN)支持后患者血清白蛋白、血清前白蛋白、血红蛋白、上臂肌围、肱三头肌皮皱厚度较支持前略有增高,但差异无统计学意义(P>0.05),住ICU期间治疗组肠屏障功能障碍发生率、MODS发生率较对照组低,差异有统计学意义(P均<0.05);呼吸机使用时间、住ICU时间治疗组较对照组明显缩短,差异有统计学意义(P均<0.05)。结论在重型颅脑创伤早期给予生大黄粉联合EN,方便、经济,能促进胃肠蠕动,有效降低肠屏障功能障碍、MODS发生率,减少呼吸机使用时间和住ICU时间。

Combination rhubarb with enteral nutrition in the nutrition support of patients with severe cerebral trauma

Objective To observe the therapeutic effect of combination rhubarb with enteral nutrition （EN） in severe craniocerebral injury patients. Methods All of 90 cases with severe cerebral trauma as well as GCS score 〈 8 were randomly divided into treatment group （EN, n = 45） and control group （PN, n = 45 ）. In treatment group, the raw rhubarb （3 -5 g, plus 30 ml warm water, and 2 -3 times per day）, combined with enteral nutritional suspension was administrated. In control group, the 3L nutrient fluid was injected through venous at 48 h after inhospital, and the dose increased with the time. Results After nutritional support, serum Alb and PAlb were significantly increased in treatment group than that in control group （ P 〈 0. 05）. The hemoglobin, arm muscle circumference and crease thickness of triceps braehii muscle were increased slightly after nutrition support, while no statistical difference （ P 〉 0.05）. In control group with parenteral nutrition, all indexes listed above were increased slightly, but no statistical significance （ P 〉 0.05）. The incidence rate of intestinal mueosal barrier dysfunction and MODS, as well as the time of using ventilator and in the ICU had significantly difference in two groups （ P 〈 0.05）. Conclusion Applying rhubarb combination with enteral nutrition at early stage of severe cerebral injury could be convenience and economic, facilitate the gastrointestinal motility, and reduce the incidence rate of intestinal mucosal barrier dysfunction and MODS, as well as the time of using ventilator and in the ICU.