早期应用肠内营养混悬液对缓解重型颅脑损伤患者应激及改善预后的作用
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摘要
目的观察早期应用肠内营养混悬液(ENS)对缓解重型颅脑损伤患者应激及改善预后的作用。方法以2013年1月~2014年10月我院收治的94例重型颅脑损伤患者作为研究对象,将其随机分为观察组及对照组,各47例,两组均予常规治疗,前者给予ENS治疗,对照组不给予ENS治疗;采用t经验比较两组患者的收缩压(SBP)、白细胞计数(WBC)、中性粒细胞(NEU)、血糖(Glu)、格拉斯哥评分(GCS)及神经功能缺损评分(NIHSS),应用秩和检验比较两组急性胃黏膜病变(AGML)及死亡例数的差异。结果急诊入院时,两组AGML发生率比较,差异无统计学意义(P>0.05);治疗后72 h,对照组的AGML发生率高于观察组(P<0.05)。急诊入院时,两组的SBP、WBC、NEU及Glu水平差异无统计学意义(P>0.05);治疗后72 h,两组上述4项指标较急诊入院时均显著下降,且观察组治疗72 h后上述4项指标均显著低于对照组(P<0.05)。急诊入院时两组患者的GCS比较差异无统计学意义(P>0.05);治疗后72 h,两组患者的GCS均较急诊入院时显著升高,且观察组显著高于对照组(P<0.05);观察组患者恢复清醒的天数明显少于对照组(P<0.05);观察组1个月内2例死亡,对照组为4例,两组病死率比较差异有统计学意义(P<0.05);观察组患者治疗后1个月的NIHSS显著低于对照组(P<0.05)。结论早期应用ENS可有效缓解重型颅脑损伤患者的应激状态并及改善预后,具有重要的临床意义。
Objective To explore the effect of early administration with enteral nutritional suspension(ENS) on stress and prognosis for patients with craniocerebral injury(CI).Methods Ninty-four CI patients of Wengyuan people′s hospital were enrolled during from January 2013 to October 2014.The CI patients were randomly divided into the observation and control group(n=47 for each group).All the CI patients were given conventional treatment and ENS was applied for the patients belonging to the observation group,but not for the control group.T test was used to compare the differences of systolic pressure(SBP),white blood cell(WBC),neutrophile granulocyte(NEU),blood glucose(Glu),Glasgow coma scale(GCS),neurologic impairment score(NIHSS) between the two groups.Rank-sum test was applied to compare the rates of acute gastric mucosal lesion(AGML) and death for the two groups.Results There was no difference of AGML rate,SBP,WBC,NEU,Glu in the time-point of emergency hospitalization between the two groups(P>0.05),but AGML rates in the control group was significantly higher,whereas SBP,WBC,NEU and Glu was significantly lower than that in the observation group at 72 h after treatment respectively(all P<0.05).There was no statistical difference of GCS in the time-point of emergency hospitalization between the two groups(P>0.05),but GCS in the observation group increased and was higher than that in the control group(P<0.05).The days to recover consciousness in the observation group was shorter that of the control group(P<0.05).There were 2 patients died in the observation group whereas 4 in the control group within 1month after treatment,presenting the significant difference of mortality between the two groups(P<0.05).NIHSS of onemonth after treatment in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Early application of enteral nutrition mixed suspension can help improve stress and progress,which is clinically significant for patients with craniocerebral injury.
Objective To explore the effect of early administration with enteral nutritional suspension(ENS) on stress and prognosis for patients with craniocerebral injury(CI).Methods Ninty-four CI patients of Wengyuan people′s hospital were enrolled during from January 2013 to October 2014.The CI patients were randomly divided into the observation and control group(n=47 for each group).All the CI patients were given conventional treatment and ENS was applied for the patients belonging to the observation group,but not for the control group.T test was used to compare the differences of systolic pressure(SBP),white blood cell(WBC),neutrophile granulocyte(NEU),blood glucose(Glu),Glasgow coma scale(GCS),neurologic impairment score(NIHSS) between the two groups.Rank-sum test was applied to compare the rates of acute gastric mucosal lesion(AGML) and death for the two groups.Results There was no difference of AGML rate,SBP,WBC,NEU,Glu in the time-point of emergency hospitalization between the two groups(P>0.05),but AGML rates in the control group was significantly higher,whereas SBP,WBC,NEU and Glu was significantly lower than that in the observation group at 72 h after treatment respectively(all P<0.05).There was no statistical difference of GCS in the time-point of emergency hospitalization between the two groups(P>0.05),but GCS in the observation group increased and was higher than that in the control group(P<0.05).The days to recover consciousness in the observation group was shorter that of the control group(P<0.05).There were 2 patients died in the observation group whereas 4 in the control group within 1month after treatment,presenting the significant difference of mortality between the two groups(P<0.05).NIHSS of onemonth after treatment in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Early application of enteral nutrition mixed suspension can help improve stress and progress,which is clinically significant for patients with craniocerebral injury.
引文
[1]Ngeli M,Fasshauer M,Sommerfeld J,et al.Prolonged continuous intravenous infusion of the dipeptide L-alanine-Lglutamine significantly increases plasma glutamine and alanine without elevating brain glutamate in patients with severe traumatic brain injury[J].Crit Care,2014,18(4):R139.
[2]陈玮,李尧,王芬芬,等.低热量肠内营养对急性期重型创伤性脑损伤患者的疗效[J].中华创伤杂志,2016,32(2):124-127.
[3]吴木莹,张为民,杜凯磊.重型颅脑损伤患者肠内营养对减少肠道多重感染的研究[J].中华医院感染学杂志,2015,25(21):4954-4956.
[4]左新阳,赵淑霞,蔡美霞,等.肠内营养混悬液对重症脑卒中预后的影响[J].中国实用神经疾病杂志,2011,14(16):43-44.
[5]陈露萍,刘维群,程军,等.早期肠内营养联合益生菌对重型颅脑损伤患者术后感染的影响研究[J].中华医院感染学杂志,2015,25(6):1357-1359.
[6]章黎,王新颖,黎介寿.综合评价危重症病人营养支持和重症监护的措施——介绍一种助记法“CAN WE FEED”[J].肠外与肠内营养,2012,19(4):250-252.
[7]刘晓蜂,周子伟,张建宁,等.序贯肠内营养对高血压脑室出血患者营养指标和预后的影响[J].世界华人消化杂志,2014,(17):2493-2497.
[8]王家泽.肠内、肠外序贯营养支持对重症颅脑损伤患者肠黏膜屏障的影响[J].中国当代医药,2015,22(9):35-37.
[9]马良.早期肠内营养与肠外营养在防治昏迷患者应激性溃疡出血和感染的疗效对比[J].实用医学杂志,2013,29(16):2713-2715.
[10]范玉梅,吴修凤.早期肠内营养干预对预防高血压脑出血患者应激性溃疡的作用[J].中国实用神经疾病杂志,2014,17(8):50-51.
[11]施桂芳,杨卫,胡红娟.危重患者早期肠内营养的临床价值研究[J].中国当代医药,2015,22(21):28-29.
[12]彭钢,年福甲.早期肠内营养对重度颅脑损伤病人治疗效果影响的相关研究[J].肠外与肠内营养,2014,21(3):148-150.
[13]过群,高伟,张家留,等.不同营养支持方式对重型颅脑损伤病人预后的影响[J].肠外与肠内营养,2014,21(4):226-227.
[14]刘兵,马笑宇,戴纯刚,等.早期肠内营养支持对颅脑损伤患者免疫状态及细胞因子的影响观察[J].中国现代医学杂志,2015,25(33):75-78.
[15]Horn SD,Kinikini M,Moore LW,et al.Enteral nutrition for patients with traumatic brain injury in the rehabilitation setting:associations with patient preinjury and injury chara cteristics and outcomes[J].Arch Phys Med Rehabil,2015,96(8 Suppl):S245-S255.
[16]吕和平,欧玉兰.肝胆外科术后早期肠内营养支持起始治疗时间的临床研究[J].当代医学,2015,21(2):37-38.
[17]马清涛,郭胜利,王英芳.重型颅脑外伤患者早期肠内营养的临床价值[J].中国当代医药,2013,20(35):50-51.
[2]陈玮,李尧,王芬芬,等.低热量肠内营养对急性期重型创伤性脑损伤患者的疗效[J].中华创伤杂志,2016,32(2):124-127.
[3]吴木莹,张为民,杜凯磊.重型颅脑损伤患者肠内营养对减少肠道多重感染的研究[J].中华医院感染学杂志,2015,25(21):4954-4956.
[4]左新阳,赵淑霞,蔡美霞,等.肠内营养混悬液对重症脑卒中预后的影响[J].中国实用神经疾病杂志,2011,14(16):43-44.
[5]陈露萍,刘维群,程军,等.早期肠内营养联合益生菌对重型颅脑损伤患者术后感染的影响研究[J].中华医院感染学杂志,2015,25(6):1357-1359.
[6]章黎,王新颖,黎介寿.综合评价危重症病人营养支持和重症监护的措施——介绍一种助记法“CAN WE FEED”[J].肠外与肠内营养,2012,19(4):250-252.
[7]刘晓蜂,周子伟,张建宁,等.序贯肠内营养对高血压脑室出血患者营养指标和预后的影响[J].世界华人消化杂志,2014,(17):2493-2497.
[8]王家泽.肠内、肠外序贯营养支持对重症颅脑损伤患者肠黏膜屏障的影响[J].中国当代医药,2015,22(9):35-37.
[9]马良.早期肠内营养与肠外营养在防治昏迷患者应激性溃疡出血和感染的疗效对比[J].实用医学杂志,2013,29(16):2713-2715.
[10]范玉梅,吴修凤.早期肠内营养干预对预防高血压脑出血患者应激性溃疡的作用[J].中国实用神经疾病杂志,2014,17(8):50-51.
[11]施桂芳,杨卫,胡红娟.危重患者早期肠内营养的临床价值研究[J].中国当代医药,2015,22(21):28-29.
[12]彭钢,年福甲.早期肠内营养对重度颅脑损伤病人治疗效果影响的相关研究[J].肠外与肠内营养,2014,21(3):148-150.
[13]过群,高伟,张家留,等.不同营养支持方式对重型颅脑损伤病人预后的影响[J].肠外与肠内营养,2014,21(4):226-227.
[14]刘兵,马笑宇,戴纯刚,等.早期肠内营养支持对颅脑损伤患者免疫状态及细胞因子的影响观察[J].中国现代医学杂志,2015,25(33):75-78.
[15]Horn SD,Kinikini M,Moore LW,et al.Enteral nutrition for patients with traumatic brain injury in the rehabilitation setting:associations with patient preinjury and injury chara cteristics and outcomes[J].Arch Phys Med Rehabil,2015,96(8 Suppl):S245-S255.
[16]吕和平,欧玉兰.肝胆外科术后早期肠内营养支持起始治疗时间的临床研究[J].当代医学,2015,21(2):37-38.
[17]马清涛,郭胜利,王英芳.重型颅脑外伤患者早期肠内营养的临床价值[J].中国当代医药,2013,20(35):50-51.