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目的探讨早期低剂量肠内营养对重症颅脑损伤患者的影响。方法将200例急性重症颅脑损伤患者按随机数字表法分为早期低剂量肠内营养组(观察组)100例与正常剂量肠内营养组(对照组)100例,起病后48h给予肠内营养支持治疗。分别于治疗前及治疗后第7天抽取静脉血,检测血清二胺氧化酶(DAO)水平、肠脂肪酸结合蛋白(IFABP)、尿乳果糖/甘露醇(L/M)水平的变化。对比2组治疗后7天内VAP发生率,气管插管率,胃食管反流率,腹胀、呕吐、胃潴留发生率,腹泻率。结果治疗前2组DAO水平、IFABP、L/M水平差异无统计学意义(P>0.05)。治疗后第7天2组DAO水平高于治疗前,IFABP、L/M水平低于治疗前,且观察组变化幅度大于对照组,差异均有统计学意义(P<0.05)。观察组VAP发生率、气管插管率低于对照组,胃食管反流、呕吐次数、胃潴留、腹泻发生率低于对照组,腹胀时间少于对照组,差异均有统计学意义(P<0.05)。结论重症颅脑损伤患者多伴有严重应激状态,肠道功能障碍明显。早期低剂量肠内营养支持治疗可以增加重症颅脑损伤患者肠黏膜上皮细胞的修复能力,提高肠黏膜组织的抗氧化能力,减轻肠壁黏膜血管通透性,减轻应激状态下肠道功能障碍,降低颅脑损伤并发症发生,有助于提高临床治愈率。
Objective To investigate the effect of early low-dose enteral nutrition on patients with severe craniocerebral injury. Methods 200 cases of acute severe craniocerebral injury were randomly divided into two groups according to random number table: 100 cases in early low dose enteral nutrition group (observation group) and 100 cases in normal dose enteral nutrition group (control group), 48 hours after onset Endodontic support treatment. Venous blood was collected before treatment and on the 7th day after treatment. Changes of serum diamine oxidase (DAO), intestinal fatty acid binding protein (IFABP) and lactulose / mannitol (L / M) levels were measured. VAP incidence, tracheal intubation rate, gastroesophageal reflux ratio, abdominal distension, vomiting, gastric retention and diarrhea rate were compared between the two groups within 7 days after treatment. Results There was no significant difference in DAO, IFABP and L / M levels between the two groups before treatment (P> 0.05). On the 7th day after treatment, the levels of DAO in two groups were higher than those before treatment, the levels of IFABP and L / M were lower than those before treatment, and the changes in observation group were greater than those in control group (P <0.05). The incidence of VAP and tracheal intubation rate in the observation group were lower than those in the control group. The incidences of gastroesophageal reflux, vomiting, gastric retention and diarrhea were lower in the observation group than those in the control group, and the bloating duration was less than that in the control group (P < 0.05). Conclusions Patients with severe craniocerebral injury are often accompanied by severe stress and have obvious intestinal dysfunction. Early low-dose enteral nutrition support treatment can increase intestinal mucosal epithelial cells repair capacity in patients with severe craniocerebral injury, improve the anti-oxidative capacity of intestinal mucosa, reduce intestinal mucosal vascular permeability and reduce intestinal dysfunction under stress , Reduce the occurrence of traumatic brain injury complications, help to improve the clinical cure rate.