重型颅脑外伤患者术后早期营养支持策略的选择与疗效分析

目的 研究三种不同早期营养支持方案下重型颅脑外伤患者术后营养状况及短期预后的差异.方法 回顾性分析2014年7月-2016年7月苏北人民医院神经外科重症监护室收治的60例重型颅脑外伤术后患者,依据不同营养支持方案分为早期联合营养组、早期肠内营养组和早期肠外营养组.记录三组患者治疗前的基础临床特征、治疗后两周内的营养数据以及神经外科重症监护室住院时间、并发症情况和GCS评分.结果 早期营养支持中,早期联合营养组患者空腹血糖、血清前白蛋白、血清总蛋白、全血血红蛋白、C-反应蛋白分别为(5.74±0.64)mmol/L、(203.80±10.45) mg/L、(61.99±1.34) g/L、(114.53 ± 2.69) g/L、(0.37±0.06) mg/dl,以上数据改善情况均优于早期肠内营养组及早期肠外营养组.早期联合营养组神经外科重症监护室住院时间(11.6±0.42)d明显低于早期肠内营养组(13.20±0.42)d及早期肠外营养组(14.65±0.42)d.早期联合营养组并发症发病率最低.早期联合营养组GCS评分(11.40±1.60)分改善最显著,差异均具有统计学意义(P＜0.05).结论 重型颅脑外伤术后早期施行肠内外联合营养治疗能显著促进患者营养指标提升,同时降低并发症发病率,缩短神经外科重症监护室住院时间,减轻昏迷程度,值得临床推广.

The choice and curative effect analysis of early postoperative nutritional support for severe traumatic brain injury patients

Objective To explore the differences of curative effect and short-term prognosis to severe traumatic brain injury patients with three different early postoperative nutritional supports.Methods A retrospective study was performed on 60 severe traumatic brain injury patients received in Neurosurgical Intensive Care Unit of Northern Jiangsu People's Hospital from July 2014 to July 2016.A total of 60 cases were randomly divided into the early enteral nutrition support therapy group,the early parenteral nutrition group,and the early compound nutrition group.The clinical indicators such as basic clinical characteristics before treatment,the nutrition data in two weeks,the length of stay in the Neurosurgical Intensive Care Unit,complications and GCS scores between the three groups were observed and analyzed.Results The indicators of early compound nutrition group were fasting blood-glucose (5.74 ± 0.64) mmol/L,prealbumin(203.80 ± 10.45) mg/L,total serum protein(61.99 ± 1.34) g/L,blood hemoglobin (114.53 ± 2.69) g/L,C-reactive protein(0.37 ± 0.06) mg/dl.The length of stay in Neurosurgical Intensive Care Unit was (11.6 ± 0.42) days in the compound nutrition group while those in the early enteral nutrition group was (13.20 ±0.42) days and those in the early parenteral nutrition group was(14.65 ± 0.42) days.The postoperative complications of the compound nutrition group were significantly lower than other two groups.The GCS scores of early compound nutrition group was(11.40 ± 1.60),which was the best in three groups.The differences were statistically significant (P ＜ 0.05).Conclusions Early compound nutrition support has an exact curative effect on postoperative severe traumatic brain injury patients in Neurosurgical Intensive Care Unit.It can obviously improve the nutrition status of patients with less complications,shorter length of stay in Neurosurgical Intensive Care Unit,higher safety and lower degree of coma,worth clinical promotion.