中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2013年
9期
956-960
,共5页
廖圣芳%陈汉民%吴国鑫%张义王%黄国河%余锦刚%管定国
廖聖芳%陳漢民%吳國鑫%張義王%黃國河%餘錦剛%管定國
료골방%진한민%오국흠%장의왕%황국하%여금강%관정국
重型颅脑损伤%亚甲蓝排泄试验%肠内营养%肠外营养
重型顱腦損傷%亞甲藍排洩試驗%腸內營養%腸外營養
중형로뇌손상%아갑람배설시험%장내영양%장외영양
Severe traumatic brain injury%Methylene blue excretion test%Enteral nutrition%Parenteral nutrition
目的 探讨亚甲蓝排泄试验在重型颅脑损伤患者早期实施合理营养支持中的应用价值.方法 将2010年1月至2012年6月入院的133例重型颅脑损伤患者作为治疗组,将2007年1月至2009年12月入院的同类患者127例作为对照组.治疗组患者于受伤第3、8、15天进行亚甲蓝排泄试验,根据患者尿液变蓝色的时间确定营养支持方式；对照组常规先采用肠内营养支持治疗,15 d后仍不能耐受肠内营养者改为肠外营养治疗.观察两组患者体质量、血清白蛋白及血红蛋白等营养情况以及并发症的发生情况.伤后3个月随访格拉斯哥预后评分(GOS)情况判断疗效.结果 治疗前两组体质量差异无统计学意义,3周后治疗组平均体质量为(56.3±5.5) kg,对照组为(52.6±5.3) kg,两组比较差异有统计学意义(t=5.93,P＜0.01)；伤后第14、21天治疗组的血清白蛋白分别为(32.7±3.4)、(34.3±3.8)g/L,血红蛋白为(113.4±12.5)、(118.5±13.3) g/L,对照组分别为(28.8±3.1)、(30.7±3.3) g/L,(102.2±11.6)、(106.7±12.4) g/L,治疗组营养状态明显优于对照组(P均＜0.05)；3个月后治疗组有效率为93.23％(124/133),对照组为84.25％(107/127),差异有统计学意义(x2=5.29,P＜0.05).结论 根据亚甲蓝排泄试验来确定重型颅脑损伤患者早期合理营养支持方式,可为患者合理提供全面营养,增强机体抵抗力,降低并发症发生率,对改善预后有重要的临床价值.
目的 探討亞甲藍排洩試驗在重型顱腦損傷患者早期實施閤理營養支持中的應用價值.方法 將2010年1月至2012年6月入院的133例重型顱腦損傷患者作為治療組,將2007年1月至2009年12月入院的同類患者127例作為對照組.治療組患者于受傷第3、8、15天進行亞甲藍排洩試驗,根據患者尿液變藍色的時間確定營養支持方式；對照組常規先採用腸內營養支持治療,15 d後仍不能耐受腸內營養者改為腸外營養治療.觀察兩組患者體質量、血清白蛋白及血紅蛋白等營養情況以及併髮癥的髮生情況.傷後3箇月隨訪格拉斯哥預後評分(GOS)情況判斷療效.結果 治療前兩組體質量差異無統計學意義,3週後治療組平均體質量為(56.3±5.5) kg,對照組為(52.6±5.3) kg,兩組比較差異有統計學意義(t=5.93,P＜0.01)；傷後第14、21天治療組的血清白蛋白分彆為(32.7±3.4)、(34.3±3.8)g/L,血紅蛋白為(113.4±12.5)、(118.5±13.3) g/L,對照組分彆為(28.8±3.1)、(30.7±3.3) g/L,(102.2±11.6)、(106.7±12.4) g/L,治療組營養狀態明顯優于對照組(P均＜0.05)；3箇月後治療組有效率為93.23％(124/133),對照組為84.25％(107/127),差異有統計學意義(x2=5.29,P＜0.05).結論 根據亞甲藍排洩試驗來確定重型顱腦損傷患者早期閤理營養支持方式,可為患者閤理提供全麵營養,增彊機體牴抗力,降低併髮癥髮生率,對改善預後有重要的臨床價值.
목적 탐토아갑람배설시험재중형로뇌손상환자조기실시합리영양지지중적응용개치.방법 장2010년1월지2012년6월입원적133례중형로뇌손상환자작위치료조,장2007년1월지2009년12월입원적동류환자127례작위대조조.치료조환자우수상제3、8、15천진행아갑람배설시험,근거환자뇨액변람색적시간학정영양지지방식；대조조상규선채용장내영양지지치료,15 d후잉불능내수장내영양자개위장외영양치료.관찰량조환자체질량、혈청백단백급혈홍단백등영양정황이급병발증적발생정황.상후3개월수방격랍사가예후평분(GOS)정황판단료효.결과 치료전량조체질량차이무통계학의의,3주후치료조평균체질량위(56.3±5.5) kg,대조조위(52.6±5.3) kg,량조비교차이유통계학의의(t=5.93,P＜0.01)；상후제14、21천치료조적혈청백단백분별위(32.7±3.4)、(34.3±3.8)g/L,혈홍단백위(113.4±12.5)、(118.5±13.3) g/L,대조조분별위(28.8±3.1)、(30.7±3.3) g/L,(102.2±11.6)、(106.7±12.4) g/L,치료조영양상태명현우우대조조(P균＜0.05)；3개월후치료조유효솔위93.23％(124/133),대조조위84.25％(107/127),차이유통계학의의(x2=5.29,P＜0.05).결론 근거아갑람배설시험래학정중형로뇌손상환자조기합리영양지지방식,가위환자합리제공전면영양,증강궤체저항력,강저병발증발생솔,대개선예후유중요적림상개치.
Objective To investigate the application value of methylene blue excretion test in early reasonable nutritional support for severe traumatic brain injury.Methods One hundred and thirty-three cases of severe traumatic brain injury admitted to hospital from January 2010 to June 2012 were chosen as treatment group,while the 127 cases of similar patients admitted to hospital from January 2007 to December 2009 were chosen as control group.Patients in treatment group underwent methylene blue excretion test in 3 days,8 days,15 days after injury,and the nutritional support ways were determined according to the elimination time of methylene blue in patients' urine.The control group conventionally receive enteral nutrition support therapy firstly,after 15 days if they still cannot be tolerant of the enteral nutrition,then parenteral nutrition therapy were adopted.The weight,serum albumin and hemoglobin circumstances of the two groups were determined and the complications were recorded.Glasgow coma score (GCS) of 3 months after injury were followed up.Results There was no significant difference on the average body weigh between these two groups before treatment.The average body weight of the treatment group was significantly higher than that of control group after 3 months treatment((56.3 ± 5.5) kg vs.(52.6 ± 5.3) kg,t =5.93,P ＜ 0.01).The serum albumin and hemoglobin of 14 d,21 d after injury were significantly higher than those of the control group (serum albumin of 14 d:(32.7 ±3.4) g/L vs.(28.8 ±3.1) g/L; serum albumin of 21 d:(34.3 ±3.8) g/L vs.(30.7 ±3.3) g/L;hemoglobin of 14 d:(113.4±12.5) g/L vs.(102.2 ±11.6) g/L;hemoglobin of 21 d:(118.5 ±13.3) g/L vs.(106.7 ± 12.4) g/L.Nutritional status of treatment group was significantly better than that of the control groupall P ＜ 0.05).After three months,the effective rate of treatment group (93.23％ (124/133)) was significantly higher than that of the control group (84.25％ (107/127)),the difference was statistically significant (x2 =5.29,P ＜ 0.05).Conclusion Determining the early reasonable nutrition support ways for patients with severe traumatic brain injury according to the elimination time of methylene blue in the urine,can provide comprehensive nutrition to patients,enhance their body resistance,reduce the incidence of complications,and create an important clinical value for improving prognosis.
