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颅脑外伤患者实施不同肠内营养方案的效果分析
作者:杨婕1  王昆鹏2  周路琦1  孟杰2  闫丽娜2  于淼2 
单位:1. 承德医学院附属医院 营养科, 河北 承德 067000;
2. 承德医学院附属医院 神经外科, 河北 承德 067000
关键词:颅脑损伤 肠内营养 肠内营养制剂 混合流食 营养状况 
分类号:R651.15
出版年·卷·期(页码):2019·47·第十二期(1456-1461)
摘要:

目的: 比较颅脑外伤患者应用3种肠内营养治疗方案的疗效。方法: 将129例颅脑外伤患者随机分为A、B、C 3组,每组43例。3组患者均由营养医师根据病情给予每公斤体重相同能量及氮量的肠内营养治疗,A组应用混合流食,B组应用肠内营养制剂,C组应用混合流食结合肠内营养制剂,观察实施干预第1、7和14天的治疗效果。结果: 对各观察指标进行重复测量数据方差分析,结果显示:时间因素对患者的血血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)、肌酐(CRE)水平,以及三头肌皮褶厚度(TSF)和上臂肌围(AMC)均有影响;分组因素对血Hb、ALB、PA、CRE水平,以及TSF、AMC有影响;时间与分组的交互因素对患者血Hb、ALB、PA、TRF、CRE水平,以及TSF、AMC均有影响,差异均有统计学意义(P<0.05)。单因素方差分析结果示:干预7 d,血Hb、ALB水平比较C组大于A、B组;血PA水平C组大于A、B组,B组大于A组;血CRE水平和TSF C组大于A组,差异均有统计学意义(P<0.05)。干预14 d,血Hb、ALB、PA水平及TRF比较C组大于A、B组,B组大于A组;血CRE水平及TSF、AMC比较均为C组大于A组,B组大于A组,差异均有统计学意义(P<0.05)。C组消化道出血和腹泻发生率低于A、B组,差异有统计学意义(P<0.05)。结论: 科学、合理的肠内营养制剂与混合流食相结合的肠内营养方案,能够改善颅脑外伤患者的营养状况,降低肠道不良反应发生率,值得临床应用和推广。

Objective: To compare the effects of different enteral nutrition on patients with craniocerebral trauma.Methods: 129 cases of patients with craniocerebral trauma were randomly divided into group A, B and C, 43 cases in each group. Different enteral nutritional schemes with same energy and nitrogen were given by dietician according to illness and weight, and then been used in three groups respectively, mixed liquid for group A, enteral nutrition preparations for group B, and mixed liquid diets combined with enteral nutrition preparations for group C. The effects was observed on 1st, 7th and 14th day.Results: The results of repeated measure of ANOVA showed that:time factor had effects on blood hemoglobin(Hb), albumin(ALB), prealbumin(PA), transferrin(TRF), creatinine(CRE) levels, and triceps skin fold(TSF), arm muscle circumference(AMC); grouping factor had effects on blood Hb, ALB, PA, CRE levels, and TSF, AMC; the interaction factor of time and grouping had effects on blood Hb, ALB, PA,TRF, CRE levels, and TSF, AMC, the differences were all statistically significant (P<0.05). The results of One-way ANOVA showed that:7th day after intervention, blood Hb and ALB levels of group C were higher than group A and group B; blood PA level of group C was higher than group A and group B, group B was higher than group A; blood CRE level and TSF of group C were higher than group A, the differences were all statistically significant (P<0.05).14th day after intervention, blood Hb, ALB, PA, TRF levels of group C were higher than group A and group B, group B was higher than group A; blood CRE level and TSF, AMC of group C were higher than group A, group B was higher than group A, the differences were all statistically significant (P<0.05). The incidences of gastrointestinal bleeding and diarrhea of group C were lower than group A and group B, the difference was statistically significant (P<0.05). Conclusion: Scientific and reasonable enteral nutrition scheme of enteral nutrition preparations combined with mixed liquid diets could improve the nutritional status of patients with craniocerebral injury as well as reducing the incidence of intestinal adverse reactions, it is worthy of clinical application and promotion.

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