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目的:对比神经外科重症患者早期肠内营养和肠外营养的疗效,探讨早期肠内营养应用的最佳时机。方法:选择神经外科住院的重症患者180例,随机分为早期肠内营养组和肠外营养组各90例,分别给予早期肠内营养和肠外营养,观察两组患者术后或入院后的第1、6、14、28天的氮平衡、血清总蛋白、血清白蛋白、GCS评分,并对比腹胀、腹泻、消化道出血等并发症发生情况;同时将早期肠内营养组随机分为A组、B组、C组三个亚组,每组30例,检测三组经治疗后第28天血清生化指标变化、并发症发生情况以及GCS评分。结果:(1)治疗后第1天、第6天,两组在血生化指标及GCS评分上比较,差异无统计学意义(P>0.05),治疗第14天,早期肠内营养组血清总蛋白与血清白蛋白水平明显高于肠外营养组,差异有统计学意义(P<0.05),第28天,早期肠内营养组血清总蛋白、血清白蛋白、氮平衡及GCS评分均明显高于肠外营养组,差异有统计学意义(P<0.05)。(2)相比肠外营养组,早期肠内营养组并发症发生率低,差异有统计学意义(P<0.05)。(3)相比A组和C组,B组患者氮平衡、血清总蛋白、血清白蛋白水平及GCS评分均较高,差异有统计学意义(P<0.05)。(4)相比A组和C组,B组患者并发症发生率均较低,差异有统计学意义(P<0.05)。结论:早期肠内营养能更好的改善患者的营养指标,并发症发生率低,是神经外科重症患者合理的营养支持方式,术后或入院后25~48h开始建立肠内营养支持,或为肠内营养支持开始最佳时机。
OBJECTIVE: To compare the efficacy of early enteral nutrition and parenteral nutrition in critically ill neurosurgical patients and to explore the optimal timing of early enteral nutrition. Methods: A total of 180 critically ill hospitalized patients with neurosurgery were enrolled in this study. They were randomly divided into early enteral nutrition group and nourishment group, 90 cases were given enteral nutrition and early enteral nutrition respectively. Postoperative or postoperative admission Nitrogen balance, serum total protein, serum albumin and GCS score on the 1st, 6th, 14th and 28th days were compared with those of complications such as abdominal distension, diarrhea and gastrointestinal bleeding. The early enteral nutrition group was randomly divided into A Group B, Group C three sub-groups, 30 cases in each group, the detection of three groups after treatment on the 28th day serum biochemical changes, complications and GCS score. Results: (1) On the 1st day and the 6th day after treatment, there was no significant difference between the two groups in blood biochemical indexes and GCS scores (P> 0.05). On the 14th day after treatment, Protein and serum albumin levels were significantly higher than that of parenteral nutrition group (P <0.05). On the 28th day, serum total protein, serum albumin, nitrogen balance and GCS scores of early enteral nutrition group were significantly higher In parenteral nutrition group, the difference was statistically significant (P <0.05). (2) Compared with parenteral nutrition group, the incidence of complications in early enteral nutrition group was low, the difference was statistically significant (P <0.05). (3) The nitrogen balance, serum total protein, serum albumin and GCS scores of patients in group B were significantly higher than those in group A and C (P <0.05). (4) Compared with group A and group C, the incidence of complications in group B was lower, the difference was statistically significant (P <0.05). Conclusion: The early enteral nutrition can improve the nutritional index of patients better, and the complication rate is lower. It is a reasonable nutritional support for severe neurosurgical patients. Enteral nutrition support is established after operation or 25 ~ 48h after admission or Enteral nutrition support starts at the best time.