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目的:比较在能量代谢测定系统(简称:代谢车)监测指导下,早期采用不同营养方式及能量组合治疗重型颅脑损伤病人的临床疗效以及并发症的发生率。方法:将符合研究标准的重型颅脑损伤病人共184例随机分为肠内营养组(EN,n=61)、肠外营养组(PN,n=62)和混合营养组(PN+EN,n=61)。采用代谢车每天清晨测定病人静息能量消耗值(REE,kcal/d)连续2周,根据REE提供适宜的能量供给病人。监测病人第1、7和第14天的血清清蛋白(ALB),血红蛋白(Hb),前清蛋白(PA)和氮平衡(NB)的变化以及伤后1个月时GOS评分;同时观察病人在营养治疗期间肺炎、呕吐、误吸和消化道出血等并发症的发生率。结果:PN+EN组病人ALB、Hb、PA和NB变化、早期肺炎与入住ICU时间等指标均优于EN组或PN组,差异有显著性统计学意义(P<0.05)。PN组病人消化道出血、呕吐、误吸的发生率最高,与其他两组比有显著性差异(P<0.05);2周后病人病死率比较,PN组发生率最高,且与其他两组比较有显著性统计学差异(P<0.05)。结论:伤后早期采用代谢车测定重型颅脑损伤病人的静息能量消耗,指导营养供给的模式更为科学准确。采用PN+EN混合营养供给模式更适合重型颅脑损伤病人早期营养支持。
OBJECTIVE: To compare the clinical efficacy and the incidence of complications in patients with severe craniocerebral injury treated with different nutritional methods and energy combinations under the guidance of the energy metabolism measurement system (abbreviation: Metabolic Vehicle). Methods: A total of 184 patients with severe craniocerebral injury who met the research criteria were randomly divided into enteral nutrition group (EN, n = 61), parenteral nutrition group (PN, n = 62) and mixed nutrition group n = 61). The metabolic car was used to measure the patient’s resting energy expenditure (REE, kcal / d) every morning for 2 consecutive weeks, and the appropriate energy was supplied to the patients according to the REE. The changes of serum albumin (ALB), hemoglobin (Hb), prealbumin (PA) and nitrogen balance (NB) at 1, 7 and 14 days and the GOS score at 1 month after injury were monitored. The incidence of complications such as pneumonia, vomiting, aspiration and gastrointestinal bleeding during nutritional therapy. Results: The changes of ALB, Hb, PA and NB, early pneumonia and ICU stay in PN + EN group were better than those in EN or PN group (P <0.05). PN patients had the highest incidence of gastrointestinal bleeding, vomiting and aspiration, which was significantly different from the other two groups (P <0.05). After 2 weeks, the incidence of gastrointestinal bleeding was the highest in PN group and the other two groups There was significant statistical difference (P <0.05). Conclusion: It is more scientific and accurate to detect the resting energy consumption of patients with severe craniocerebral injury by means of metabolic cart in the early stage after injury. The PN + EN mixed nutrition supply mode is more suitable for early nutritional support in patients with severe craniocerebral injury.