重型颅脑损伤后早期肠内营养相关并发症分析

目的:观察重型颅脑损伤后早期肠内营养(EN)相关并发症的发生特点、相关因素及防治措施.方法:360例接受早期肠内营养支持的重型颅脑损伤病人,入住ICU后进行GCS评分,置鼻胃(肠)管,48 h后开始EN,观察伤后第7 d EN最大输注量(mL/d)、过渡至完全肠内营养(TEN)的时间(d)、伤后第7 d实现TEN的病例数及血糖和血清清蛋白(ALB)和谷丙转氨酶变化,记录各种肠内营养并发症的发生率.结果:颅脑损伤后早期EN并发症发生特点:伤后1周内以腹胀、呕吐、反流和误吸为主,1周后以腹泻为主;腹胀和呕吐的发生与鼻饲管所在位置有关,腹泻发生与GCS评分和ALB水平呈负相关;GCS评分越低,EN耐受的最大输注量越低、过渡至TEN的时间越长、相关并发症的发生率亦增加.结论:重型颅脑损伤后早期肠内营养相关并发症与其损伤程度、血清清蛋白水平等因素呈负相关;使用鼻肠管可降低腹胀和呕吐的发生率.

Analysis of the complications related to early enteral nutrition in severe head injured patients

Objectives:To observe the clinical features,related factors,prevention and treauments of complications on early enteral nutrition(EN) in severe head injured patients.Methods:360 patients with severe head injuries were enrolled in this study.GCS score was used to assess the patient's situation.After nasogastric(jejunal) tube was inserted,enteral nutrition was started from 48 hours after injury.The maximal EN volume(mL/d) in the first week after injury,time used for reaching to TEN(d),number of patients that achieved TEN in the first week following injury,blood glucose,serum albumin and ALT were observed.The complications due to enteral nutrition were analyzed. Results:Features of complications with early EN were that the abdominal distension,vomiting and aspiration were found in the first week and diarrhea occurred in the following weeks.A positive correlation between abdominal distension,vomiting and nasogastric tube was noted,while diarrhea had a negative correlation to GCS score and albumin level. Conclusions:The complications related to early enteral nutrition after severe head trauma correlated inversely to the degree of injury and serum albumin level.Utilization of nasojejunal tube could decrease the incidences of abdominal distension and vomiting.