中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2010年
4期
199-202
,共4页
重型颅脑损伤%肠内营养%胃液pH值%消化道出血
重型顱腦損傷%腸內營養%胃液pH值%消化道齣血
중형로뇌손상%장내영양%위액pH치%소화도출혈
Severe brain injury%Enternal nutrition%Gastric juice pH%Gastrointestinal hemorrhage
目的 探讨实施早期肠内营养和肠外营养对重型颅脑损伤患者胃液pH值的影响.方法 我院2007年1月至2009年5月间收治的168例重型颅脑损伤患者(格拉斯哥昏迷评分≤8分)随机分为早期肠内营养组(EEN组,n=84)和肠外营养组(PN组,n=84),其中EEN组患者鼻腔内插入14F硅胶胃管进行早期肠内营养,PN组患者给予全静脉营养.分别于入院即刻和入院后第3、5、7天监测患者胃液pH值及消化道出血情况.结果 两组患者入院即刻胃液pH值均明显低于正常值,ENN组患者入院后第3、5、7天胃液pH值均明显高于PN组(P＜0.001).两组患者入院即刻消化道出血发生率差异无统计学意义(P＞0.05),EEN组患者入院后第3、5、7天消化道出血发生率均明显低于PN组(P＜0.05).结论 重型颅脑损伤患者胃酸呈高分泌状态,给予早期肠内营养支持可升高胃液pH值,可能对降低上消化道出血发生率起一定作用.监测胃液pH值对应激性溃疡出血的发生具有预警作用.
目的 探討實施早期腸內營養和腸外營養對重型顱腦損傷患者胃液pH值的影響.方法 我院2007年1月至2009年5月間收治的168例重型顱腦損傷患者(格拉斯哥昏迷評分≤8分)隨機分為早期腸內營養組(EEN組,n=84)和腸外營養組(PN組,n=84),其中EEN組患者鼻腔內插入14F硅膠胃管進行早期腸內營養,PN組患者給予全靜脈營養.分彆于入院即刻和入院後第3、5、7天鑑測患者胃液pH值及消化道齣血情況.結果 兩組患者入院即刻胃液pH值均明顯低于正常值,ENN組患者入院後第3、5、7天胃液pH值均明顯高于PN組(P＜0.001).兩組患者入院即刻消化道齣血髮生率差異無統計學意義(P＞0.05),EEN組患者入院後第3、5、7天消化道齣血髮生率均明顯低于PN組(P＜0.05).結論 重型顱腦損傷患者胃痠呈高分泌狀態,給予早期腸內營養支持可升高胃液pH值,可能對降低上消化道齣血髮生率起一定作用.鑑測胃液pH值對應激性潰瘍齣血的髮生具有預警作用.
목적 탐토실시조기장내영양화장외영양대중형로뇌손상환자위액pH치적영향.방법 아원2007년1월지2009년5월간수치적168례중형로뇌손상환자(격랍사가혼미평분≤8분)수궤분위조기장내영양조(EEN조,n=84)화장외영양조(PN조,n=84),기중EEN조환자비강내삽입14F규효위관진행조기장내영양,PN조환자급여전정맥영양.분별우입원즉각화입원후제3、5、7천감측환자위액pH치급소화도출혈정황.결과 량조환자입원즉각위액pH치균명현저우정상치,ENN조환자입원후제3、5、7천위액pH치균명현고우PN조(P＜0.001).량조환자입원즉각소화도출혈발생솔차이무통계학의의(P＞0.05),EEN조환자입원후제3、5、7천소화도출혈발생솔균명현저우PN조(P＜0.05).결론 중형로뇌손상환자위산정고분비상태,급여조기장내영양지지가승고위액pH치,가능대강저상소화도출혈발생솔기일정작용.감측위액pH치대응격성궤양출혈적발생구유예경작용.
Objective To evaluate the influence of early entemal nutrition and parenteral nutrition support on gastric juice pH in patients with severe brain injury. Methods Totally 168 patients with severe brain injury ( Glasgow Coma Scale ≤ 8 ) admitted to our hospital from January 2007 to May 2009 were equally and randomly divided into early enternal nutrition (EEN) group and parenteral nutrition (PN) group. Gastric juice pH and upper gastrointestinal hemorrhage were monitored on admission and on the 3rd, 5th, and 7th day after admission. Results The gastric juice pH was significantly decreased in patients with severe brain injury. In addition, it was significantly higher in EEN group than in PN group on the 3rd, 5th, and 7th day after admission ( P ＜ 0. 001 ). The alimentary tract hemorrhage incidence showed no difference on admission between two groups but was significantly lower in the EEN group on the 3rd, 5th, and 7th day ( P ＜ 0. 05 ). Conclusions Hypersecretion of gastric acid may occur in patients with severe brain injury. EEN can neutralize gastric acid and increase gastric juice pH,which may lead to the decrease of upper gastriontestiual hemorrhage. Monitoring of the gastric juice pH also can provide a warning message of stress ulcer bleeding.
