重症脑出血患者采用不同营养剂行早期肠内营养支持治疗的临床效果比较
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摘要
目的比较重症脑出血患者采用不同营养剂行早期肠内营养支持治疗的临床效果。方法选取2016年9月1日至2018年8月31日在山西医科大学附属人民医院治疗的100例重症脑出血患者作为研究对象。按照随机数字表法分为观察组和对照组,各50例。其中对照组采用自制匀浆膳肠内支持治疗,观察组采用肠内营养乳剂营养支持治疗。观察评估2组患者治疗前后血清总蛋白、前白蛋白、白蛋白与血红蛋白水平,急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分以及消化相关并发症发生情况。结果治疗前2组患者各营养指标及APACHEⅡ评分差异无统计学意义(P> 0. 05)。治疗10 d后,观察组血清总蛋白、前白蛋白、白蛋白与血红蛋白均较治疗前明显升高、且高于对照组[(75±3) g/L比(62±4) g/L、(269±42) mg/L比(224±32) mg/L、(48. 2±3. 1) g/L比(28. 4±1. 6) g/L、(133±6) g/L比(100±15) g/L],APACHEⅡ评分较治疗前明显下降且低于对照组[(10. 1±2. 6)分比(18. 4±2. 6)分],差异均有统计学意义(均P <0. 05)。观察组消化相关并发症发生率低于对照组[14. 0%(7/50)比38. 0%(19/50)],差异有统计学意义(P <0. 01)。结论与自制匀浆膳支持治疗相比,重症脑出血患者采用肠内营养乳剂营养支持治疗能够更好地改善患者机体营养状态、增强患者抵抗力、减少消化相关并发症发生、改善患者预后。
Objective To analyze the clinical effect of early enteral nutrition support therapy with different nutrients on patients with severe cerebral hemorrhage. Methods A total of 100 patients with severe cerebral hemorrhage in People' s Hospital Affiliated to Shanxi Medical University were enrolled between September 1 st,2016 and August 31 st,2018. The patients were randomly divided into observation group and control group,with50 cases in each group. The control group had enteral nutrition support with self-made homogenate and the observation group was treated by nutritional emulsion. Levels of serum total protein,prealbumin,albumin and hemoglobin,score of Acute Physiology and Chronic Health Evaluation Ⅱ( APACHEⅡ) and incidence of digestive complications were analyzed. Results There was no significant difference of nutrition indexes and APACHE Ⅱscore between groups before treatment( P > 0. 05). After 10 d treatment,levels of serum total protein,prealbumin,albumin and hemoglobin were improved in observation group and they were significantly higher than those before treatment and those in control group [( 75 ± 3) g/L vs( 62 ± 4) g/L,( 269 ± 42) mg/L vs( 224 ± 32) mg/L,( 48. 2 ± 3. 1) g/L vs( 28. 4 ± 1. 6) g/L,( 133 ± 6) g/L vs( 100 ± 15) g/L]( all P < 0. 05); APACHEⅡ score decreased significantly and the score in observation group was lower than that in control group[( 10. 1 ± 2. 6) vs( 18. 4 ± 2. 6) ]( P < 0. 05). Incidence of digestive complications in observation group was significantly lower than that in control group[14. 0%( 7/50) vs 38. 0%( 19/50) ]( P < 0. 01). Conclusion Enteral nutrition support therapy with nutritional emulsion treating severe cerebral hemorrhage can markedly improve nutrition status and resistibility of patients,reduce complications and improve the prognosis.
Objective To analyze the clinical effect of early enteral nutrition support therapy with different nutrients on patients with severe cerebral hemorrhage. Methods A total of 100 patients with severe cerebral hemorrhage in People' s Hospital Affiliated to Shanxi Medical University were enrolled between September 1 st,2016 and August 31 st,2018. The patients were randomly divided into observation group and control group,with50 cases in each group. The control group had enteral nutrition support with self-made homogenate and the observation group was treated by nutritional emulsion. Levels of serum total protein,prealbumin,albumin and hemoglobin,score of Acute Physiology and Chronic Health Evaluation Ⅱ( APACHEⅡ) and incidence of digestive complications were analyzed. Results There was no significant difference of nutrition indexes and APACHE Ⅱscore between groups before treatment( P > 0. 05). After 10 d treatment,levels of serum total protein,prealbumin,albumin and hemoglobin were improved in observation group and they were significantly higher than those before treatment and those in control group [( 75 ± 3) g/L vs( 62 ± 4) g/L,( 269 ± 42) mg/L vs( 224 ± 32) mg/L,( 48. 2 ± 3. 1) g/L vs( 28. 4 ± 1. 6) g/L,( 133 ± 6) g/L vs( 100 ± 15) g/L]( all P < 0. 05); APACHEⅡ score decreased significantly and the score in observation group was lower than that in control group[( 10. 1 ± 2. 6) vs( 18. 4 ± 2. 6) ]( P < 0. 05). Incidence of digestive complications in observation group was significantly lower than that in control group[14. 0%( 7/50) vs 38. 0%( 19/50) ]( P < 0. 01). Conclusion Enteral nutrition support therapy with nutritional emulsion treating severe cerebral hemorrhage can markedly improve nutrition status and resistibility of patients,reduce complications and improve the prognosis.
引文
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[6]Seron-Arbeloa C,Zamora-Elson M,Labarta-Monzon L,et al.Enteral nutrition in critical care[J].J Clin Med Res,2013,5(1):1-11.DOI:10.4021/jocmr1210w.
[7]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.DOI:10.3760/cma.j.issn.1006-7876.2015.06.002.Society of Neurology,Chinese Medical Association,Cerebrovascular Disease Group,Society of Neurology,Chinese Medical Association.Chinese guidelines for the diagnosis and treatment of cerebral hemorrhage(2014)[J].Chinese Journal of Neurology,2015,48(6):435-444.DOI:10.3760/cma.j.issn.1006-7876.2015.06.002.
[8]Suarez JI,Martin RH,Calvillo E,et al.Effect of human albumin on TCD vasospasm,DCI,and cerebral infarction in subarachnoid hemorrhage:the ALISAH study[J].Acta Neurochir Suppl,2015(120):287-290.DOI:10.1007/978-3-319-04981-6_48.
[9]Palesch YY,Hill MD,Ryckborst KJ,et al.The ALIAS Pilot Trial:a dose-escalation and safety study of albumin therapy for acute ischemic stroke-Ⅱ:neurologic outcome and efficacy analysis[J].Stroke,2006,37(8):2107-2114.DOI:10.1161/01.STR.0000231389.34701.b5.
[2]Corrigan ML,Escuro AA,Celestin J,et al.Nutrition in the stroke patient[J].Nutr Clin Pract,2011,26(3):242-252.DOI:10.1177/0884533611405795.
[3]Emsley HC,Smith CJ,Tyrrell PJ,et al.Inflammation in acute ischemic stroke and its relevance to stroke critical care[J].Neurocritical Care,2008,9(1):125-138.DOI:10.1007/s12028-007-9035-x.
[4]Gariballa SE,Parker SG,Taub N,et al.Influence of nutritional status on clinical outcome after acute stroke[J].Am J Clin Nutr,1998,68(2):275-281.
[5]Rice TW,Mogan S,Hays MA,et al.Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure[J].Crit Care Med,2011,39(5):967-974.DOI:10.1097/CCM.0b013e31820a905a.
[6]Seron-Arbeloa C,Zamora-Elson M,Labarta-Monzon L,et al.Enteral nutrition in critical care[J].J Clin Med Res,2013,5(1):1-11.DOI:10.4021/jocmr1210w.
[7]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.DOI:10.3760/cma.j.issn.1006-7876.2015.06.002.Society of Neurology,Chinese Medical Association,Cerebrovascular Disease Group,Society of Neurology,Chinese Medical Association.Chinese guidelines for the diagnosis and treatment of cerebral hemorrhage(2014)[J].Chinese Journal of Neurology,2015,48(6):435-444.DOI:10.3760/cma.j.issn.1006-7876.2015.06.002.
[8]Suarez JI,Martin RH,Calvillo E,et al.Effect of human albumin on TCD vasospasm,DCI,and cerebral infarction in subarachnoid hemorrhage:the ALISAH study[J].Acta Neurochir Suppl,2015(120):287-290.DOI:10.1007/978-3-319-04981-6_48.
[9]Palesch YY,Hill MD,Ryckborst KJ,et al.The ALIAS Pilot Trial:a dose-escalation and safety study of albumin therapy for acute ischemic stroke-Ⅱ:neurologic outcome and efficacy analysis[J].Stroke,2006,37(8):2107-2114.DOI:10.1161/01.STR.0000231389.34701.b5.