CAJ | 학술논문

目的：探讨开始营养支持和达到完全热量摄入的时间对儿童重型颅脑外伤（TBI）患者在ICU的治疗时间和预后的影响。方法对109例入住ICU的儿童重型 TBI患者的资料进行回顾性分析。入院后开始营养支持，记录患者入IC U后的营养支持方式、开始时间和达到完全热量摄入的时间，统计分析其与患者IC U 治疗时间和预后的相关性。结果本组19例患者未开始营养支持前即死亡，余下的90例中入院后营养支持开始时间平均为（1．49±0．82）d；89例达到完全热量摄入的平均时间为（3．39±0．71）d ，在IC U的平均治疗时间为（2．09±1．01）d。本组出院时根据儿童脑功能分级量表评估，57．8％的患者恢复良好，33．3％的患者残疾，8．9％的患者死亡或昏迷状态。统计显示，入ICU后开始营养支持时间和达到完全热量摄入天数与ICU治疗天数呈正性相关（P＜0．01），开始营养支持时间和达到完全热量摄入天数越短预后越好（P＜0．05）。结论早期营养支持可缩短儿童重型 TBI患者在IC U的治疗时间和改善预后。
목적：탐토개시영양지지화체도완전열량섭입적시간대인동중형로뇌외상（TBI）환자재ICU적치료시간화예후적영향。방법대109례입주ICU적인동중형 TBI환자적자료진행회고성분석。입원후개시영양지지，기록환자입IC U후적영양지지방식、개시시간화체도완전열량섭입적시간，통계분석기여환자IC U 치료시간화예후적상관성。결과본조19례환자미개시영양지지전즉사망，여하적90례중입원후영양지지개시시간평균위（1．49±0．82）d；89례체도완전열량섭입적평균시간위（3．39±0．71）d ，재IC U적평균치료시간위（2．09±1．01）d。본조출원시근거인동뇌공능분급량표평고，57．8％적환자회복량호，33．3％적환자잔질，8．9％적환자사망혹혼미상태。통계현시，입ICU후개시영양지지시간화체도완전열량섭입천수여ICU치료천수정정성상관（P＜0．01），개시영양지지시간화체도완전열량섭입천수월단예후월호（P＜0．05）。결론조기영양지지가축단인동중형 TBI환자재IC U적치료시간화개선예후。
Objective To study the effect and timing for nutritional supplement initiation and achieving full caloric intake for treatment and outcome for patients with severe traumatic brain injury (TBI) during the stay in ICU . Method A retrospective analysis of 109 cases of children with TBI admitted to ICU was made .The nutritional sup-port way ,nutritional support start time after admission to ICU ,completely calorie intake time and days of ICU stay were recorded and compared relatively .The outcome of these patients was made on discharge according to pediatric cerebral performance category (PCPC) .The relationship between both the nutritional support start time and com-pletely calorie intake time and both days of ICU stay and outcome on discharge was analyzed .Result 19 patients died before starting nutritional support .Among the remaining 90 cases ,the average start time of nutritional support after admitting to ICU was(1 .49 ± 0 .82) days ,and completely calorie intake was achieved in 89 cases .In these 89 cases , the mean time was (3 .39 ± 0 .71) days and mean days of ICU stay was (2 .09 ± 1 .01) days .According to PCPC , 57 .8% of patients were discharged with good recovery ,33 .3% with disability and 8 .9% with coma or death .Sta-tistical analysis showed timing of start nutritional support and completely calorie intake were both positively correla-ted with days of ICU stay (P<0 .01) .And the shorter of timing of start nutritional support and completely calorie intake ,the better of outcome(P<0 .05) .Conclusion Early initiation of nutritional support may shorten the days of ICU stay and improve its outcome for child patients with severe traumatic brain injury .