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目的:探讨重型颅脑损伤病人序贯性肠内营养(EN)治疗的方案、可行性及临床效果。方法:将59例重型颅脑损伤病人随机分为研究组和对照组。研究组30例病人采用短肽型EN制剂过渡至整蛋白型EN制剂的序贯性EN治疗方案,对照组29例开始即采用整蛋白型EN制剂,根据操作流程实施。观察两组病人达到EN目标量的时间、需联合肠外营养(PN)治疗的比例、低清蛋白(ALB)血症率、喂养相关并发症、平均入住ICU天数等指标。结果:两组病人均能达到EN目标治疗,研究组开始EN治疗后达到EN目标量的时间早于对照组(P<0.05),联合PN治疗的比例小于对照组(P<0.05),ALB水平高于对照组(P<0.05),腹胀发生率低于对照组(P<0.05)。两组间其他喂养相关并发症和平均入住ICU时间无统计学差异。结论:对重型颅脑损伤后病人尤其是肠道吸收功能障碍者推荐采用序贯性EN支持治疗。
Objective: To discuss the treatment plan, feasibility and clinical effect of sequential enteral nutrition (EN) in patients with severe craniocerebral injury. Methods: 59 cases of severe traumatic brain injury were randomly divided into study group and control group. In the study group, 30 patients underwent sequential EN treatment with the transition from short peptide EN preparation to whole protein EN preparation. The control group received the whole protein preparation from the beginning of 29 cases according to the procedure. The time required to reach the EN target for both groups was observed, and the proportion of parenteral nutrition (PN), the rate of hypoalbuminemia (ALB), feeding-related complications, and the number of ICU days per day were observed. Results: The EN target treatment was achieved in both groups. The time to reach EN target after initiation of EN treatment in the study group was earlier than that in the control group (P <0.05), and that in the PN group was less than that in the control group (P <0.05) Higher than the control group (P <0.05), the incidence of abdominal distension was lower than that of the control group (P <0.05). There were no significant differences in other feeding-related complications and mean ICU stay between the two groups. Conclusions: Sequential EN supportive therapy is recommended for patients with severe craniocerebral injury, especially those with impaired intestinal absorption.