综合营养治疗对重型颅脑损伤患者的研究
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摘要
目的 研究不同营养方式对重型颅脑损伤后代谢指标变化及预后的意义。方法 回顾性分析泰州市中医院2015年2月—2017年2月期间收治的75例重型颅脑损伤患者,根据所采用的不同营养方式分为综合营养(GN)组、肠外营养(PN)组和肠内营养(EN)组3组,各25例。通过监测三种营养方式对重型颅脑损伤后的高代谢反应指标,观察各组并发症的发生及预后情况。结果 伤后第7天GN组、PN组、EN组排氮量分别为(11.8±2.6)g/d、(16.2±1.8)g/d、(17.5±3.1)g/d,显示GN组明显低于PN组、EN组(P<0.05);血浆皮质醇浓度(nmol/L)在第28天时GN组、PN组、EN组分别为(659.1±87.4)nmol/L、(973.9±231.6)nmol/L、(793.2±221.8)nmol/L,GN组明显低于其他前两组(P<0.05);伤后4周内GN组并发症发生率及病死率均明显低于PN组、EN组(P<0.05)。结论 早期综合营养既发挥了肠内及肠外营养的各自优势,又消弭了两者的不足,能有效改善预后和降低病死率和致残率。
Objective To study the significance of different nutritional methods on the changes of metabolic index and prognosis after severe craniocerebral trauma. Methods A retrospective analysis of 75 patients with severe craniocerebral injury admitted to Taizhou Hospital of Traditional Chinese Medicine from Feb.2015 to Feb. 2017 was divided into general nutrition(GN) group and parenteral nutrition(PN) group and enteral nutrition(EN) group according to different nutritional methods. There were 25 cases in each group. By monitoring the high metabolic response after severe head injury,the occurrence of complication and prognosis of each group were observed. Results On the 7 th day after injury,the nitrogen excretion of the three groups were(11.8±2.6) g/d in the GN group,(16.2 ±1.8) g/d in the PN group,and(17.5 ±3.1) g/d in the EN group,which showed that GN group was significantly lower than PN and EN group(P<0.05). On the 28 th day,the plasma cortisol concentration was(659.1±87.4)nmol/L,(973.9±231.6)nmol/L,(793.2±221.8)nmol/L,respectively. GN group was significantly lower than the other two groups(P<0.05),and the complications and mortality in GN group were significantly lower than those in the other two groups within 4 weeks after injury(P<0.05). Conclusion Early comprehensive nutrition not only exerts the respective advantages of enteral and parenteral nutrition,but also eliminates their deficiencies. It can effectively improve the prognosis and reduce the mortality and disability rate.
Objective To study the significance of different nutritional methods on the changes of metabolic index and prognosis after severe craniocerebral trauma. Methods A retrospective analysis of 75 patients with severe craniocerebral injury admitted to Taizhou Hospital of Traditional Chinese Medicine from Feb.2015 to Feb. 2017 was divided into general nutrition(GN) group and parenteral nutrition(PN) group and enteral nutrition(EN) group according to different nutritional methods. There were 25 cases in each group. By monitoring the high metabolic response after severe head injury,the occurrence of complication and prognosis of each group were observed. Results On the 7 th day after injury,the nitrogen excretion of the three groups were(11.8±2.6) g/d in the GN group,(16.2 ±1.8) g/d in the PN group,and(17.5 ±3.1) g/d in the EN group,which showed that GN group was significantly lower than PN and EN group(P<0.05). On the 28 th day,the plasma cortisol concentration was(659.1±87.4)nmol/L,(973.9±231.6)nmol/L,(793.2±221.8)nmol/L,respectively. GN group was significantly lower than the other two groups(P<0.05),and the complications and mortality in GN group were significantly lower than those in the other two groups within 4 weeks after injury(P<0.05). Conclusion Early comprehensive nutrition not only exerts the respective advantages of enteral and parenteral nutrition,but also eliminates their deficiencies. It can effectively improve the prognosis and reduce the mortality and disability rate.
引文
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[2] Scheff SW,Dhillon HS.Creatine-enhanced diet alters levels of lactate and free acids after experimental brain injury[J].Neurochem Res,2016,29(2):469-479.
[3] 黎介寿.严重创伤病人营养支持的研究进展[J].中华创伤杂志,2009,25(7):405-406.
[4] Gosling P.The cellular,immune,and metabolic response to trauma[J].Crit Rev Clin Lab Sci,2016,35(1):59-112.
[5] Roberts PR.Nutrition in the head-injured patient[J].New Hoviz,2015,3:506-509.
[6] Fruin AH,Tayler C,Pettis S.Caloric requirements in patients with severe head injury[J].Surg Neruol,2014,45(4):64-67.
[7] Kaufman HH,Bretaudiere JP,Rowlands BJ,et al.General metabolism in head injury[J].Neurosurgery,2016,21(2):256-258.
[8] Datta G,Gnannalingham KK,van Dellen J,et al.The role of parenteral nutrion as asupplement to enteral nutrition in patients with severe brain injury[J].Br J Neurosurg,2015,17(4):432-434.