(曾凡)早期肠内营养在重型颅脑损伤合并应激性高血糖中的应用价值.doc

早期肠内营养在重型颅脑损伤合并应激性高血糖中的应用价值 曾凡 程燕子 赵灵 （广东省珠海市人民医院重症监护科，广东珠海 519000） 通讯作者 赵灵 【摘要】目的 探讨早期肠内营养在重型颅脑损伤合并应激性高血糖中的应用价值。方法 回顾性分析60例重型颅脑损伤合并应激性高血糖患者的临床资料，根据给予肠内营养的时间分为早期肠内营养组与延迟肠内营养组。观察两组患者应激性高血糖的控制情况、低血糖发生率、感染并发症发生率、死亡率等。结果 早期肠内营养组肠内营养第7天的平均血糖、胰岛素使用总时间与低血糖发生率均低于延迟肠内营养组，差异有统计学意义（P ＜ 0.05）；早期肠内营养组肺部感染发生率低于延迟肠内营养组，差异有统计学意义（P ＜ 0.05）；消化道出血、呼吸机使用时间以及28天死亡率均低于延迟肠内营养组，但差异无显著统计学意义（P ＞ 0.05）。结论 早期肠内营养有利于重型颅脑损伤应激性高血糖的控制，对于改善患者的预后具有积极意义。 【关键词】应激性高血糖 ；肠内营养 ；重型颅脑损伤 Early enteral nutrition play the role in severe brain injury with stress hyperglycemia [Abstract] Objective： To investigate the role of early enteral nutrition in severe head injury patients with stress hyperglycemia. Methods：a retrospective analysis of 60 cases of severe head injury complicated with stress hyperglycemia patients, according to the given enteral nutrition time divided into early enteral nutrition group and delayed enteral nutrition group. To observe two groups of patients with stress hyperglycemia the condition of blood glucose control, incidence of hypoglycemia, the infectious complication rate, mortality rate and so on. Results： the average blood glucose after seven days enteral nutrition, the time of insulin use and the rate of hypoglycemia in early enteral nutrition group were lower than delayed enteral nutrition group, the difference was statistically significant ( P 0.05); the incidence of pulmonary infection in early enteral nutrition group is lower than delayed enteral nutrition group, the difference was statistically significant ( P 0.05); gastrointestinal hemorrhage, ventilation time and a 28 day mortality rates were lower than the delayed enteral nutrition group, but the difference was not statistically significant ( P 0.05). Conclusion: early enteral nutrition is useful for the control of stress hyperglycemia of severe head injury and to improve the prognosis of the patients with positive role. [Keywords] Stress Hyperglycemia; Enteral Nutrition; Severe Traumatic Brain Injury 重型颅脑损伤患者经常出现应激性高血