经鼻肠管和鼻胃管肠内营养对重型颅脑损伤患者预后及并发症的影响

目的观察经鼻肠管和鼻胃管肠内营养对重型颅脑损伤患者预后及并发症的影响。方法纳入我院2016年7月-2017年12月期间收治的重型颅脑损伤患者82例进行研究,采用随机数字表法分为鼻肠管组和鼻胃管组,各41例,分别予以经鼻肠管肠内营养、经鼻胃管肠内营养。观察并比较两组患者治疗前、治疗10 d后的营养状态相关指标[血红蛋白(Hb)、血清白蛋白(Alb)、血清前白蛋白(PAB)]、血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、超敏C反应蛋白(hs-CPR)],以及治疗期间并发症发生率。结果治疗10 d后,两组患者Hb、Alb、PAB水平均较治疗前升高(P均<0.05),且鼻肠管组患者上述指标水平明显高于鼻胃管组(P均<0.05);两组患者血清TNF-α、IL-1β、hs-CPR水平均较治疗前明显降低(P均<0.05),且鼻肠管组患者明显低于鼻胃管组(P均<0.05);两组患者腹泻、腹胀发生率对比差异无统计学意义(P均>0.05);鼻肠管组患者返流、误吸、肺部感染发生率均低于鼻胃管组(P均<0.05)。结论经鼻肠管营养支持可更有效地改善重症颅脑损伤患者短期营养状态,抑制炎性反应,并减少返流、误吸、肺部感染等并发症的发生率。

Effects of Enteral Nutrition Through Nasointestinal Tube and Nasogastric Tube on Prognosis and Complications in Patients with Severe Craniocerebral Injury

Objective To observe the effects of enteral nutrition through nasointestinal tube and nasogastric tube on the prognosis and complications of patients with severe craniocerebral injury. Methods A total of 82 patients with severe craniocerebral injury admitted to our hospital from July 2016 to December 2017 were enrolled in the study. According to the random number table method, the patients were divided into nasointestinal tube group and nasogastric tube group, with 41 cases in each group. The two groups were given nasointestinal enteral nutrition and nasogastric enteral nutrition respectively. The related indexes of nutritional status 〔hemoglobin (Hb), serum albumin (Alb), serum prealbumin (PAB)〕 and serum inflammatory factors 〔tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), hypersensitive C-reactive protein (hs-CPR)〕 before treatment and after 10 d of treatment, and the incidence rate of complications during treatment were observed and compared between the two groups. Results After 10 d of treatment, the levels of Hb, Alb and PAB in the two groups were higher than those before treatment (all P <0.05), and the levels of the above indexes in nasointestinal tube group were significantly higher than those in nasogastric tube group ( P <0.05). The levels of serum TNF-α, IL-1β and hs-CPR in the two groups were significantly lower than those before treatment (all P <0.05), and the levels in nasointestinal tube group were significantly lower than those in nasogastric tube group (all P <0.05). There were no significant differences in the incidence rates of diarrhea and abdominal distension between the two groups (all P >0.05). The incidence rates of reflux, aspiration and lung infection in nasointestinal tube group were lower than those in nasogastric tube group (all P <0.05). Conclusion Nasointestinal tube nutrition support can effectively improve the short-term nutritional status of patients with severe craniocerebral injury, inhibit the inflammatory response, and reduce the incidence rates of complications of reflux, aspiration and lung infection.