CAJ | 학술논문

目的：比较序贯性肠内营养(SEN)与肠外营养(PN)在重症脑出血患者治疗中的应用效果。方法回顾性分析北京天坛医院急诊ICU于2009年8月~2011年9月收治的重症脑出血患者808例的临床资料。根据本研究设计的病例入选标准随机抽取108例患者纳入研究，根据治疗方法不同，将这些患者分为两组：SEN组(n =57)及PN组(n=51)。 SEN组在入院第1天开始给予肠内营养混悬液(SP)，2~3 d后予以肠内营养混悬液(TPF)；PN组予以等热卡的脂肪乳氨基酸(17)葡萄糖(11%)注射液，疗程为14 d。入院第1、18天，采用美国国立卫生研究院卒中量表(NIHSS)及格拉斯哥昏迷量表(GCS)进行评分，观察两组体重、血红蛋白、血清白蛋白、血清前白蛋白、转铁蛋白等营养情况指标以及并发症的发生情况。结果两组入院第1天的体重、血红蛋白、血清白蛋白、血清前白蛋白、转铁蛋白水平组间比较，差异无统计学意义(P>0.05)。 SEN组与PN组入院第18天的体重[(54.3±5.2)比(50.8±4.9)kg]、血红蛋白[(115.6±12.1)比(104.7±10.5)g/L]、血清白蛋白[(32.2±3.3)比(29.3±3.0)g/L]、血清前白蛋白[(193.4±15.5)比(167.2±13.5)mg/L]、转铁蛋白[(2.29±0.62)比(1.73±0.46)g/L]组间比较，差异均有统计学意义(均P<0.05)。两组入院第1、18天的NIHSS评分组间比较差异无统计学意义(P>0.05)；两组入院第18天的NIHSS评分与入院第1天比较，差异无统计学意义(P>0.05)。 SEN组入院第18天的GCS评分高于入院第1天[(8.32±1.47)比(6.45±1.39)分，P<0.05]及PN组[(8.32±1.47)比(6.72±1.84)分，P<0.05)]，差异有统计学意义。SEN组的胃出血、肺部感染、肠源性感染发生率低于PN组(14.04%比33.33%，19.30%比35.29%，7.02%比17.65%，均 P<0.05)。结论早期合理的肠内营养支持可为重症脑出血患者提供全面营养，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：比較序貫性腸內營養(SEN)與腸外營養(PN)在重癥腦齣血患者治療中的應用效果。方法迴顧性分析北京天罈醫院急診ICU于2009年8月~2011年9月收治的重癥腦齣血患者808例的臨床資料。根據本研究設計的病例入選標準隨機抽取108例患者納入研究，根據治療方法不同，將這些患者分為兩組：SEN組(n =57)及PN組(n=51)。 SEN組在入院第1天開始給予腸內營養混懸液(SP)，2~3 d後予以腸內營養混懸液(TPF)；PN組予以等熱卡的脂肪乳氨基痠(17)葡萄糖(11%)註射液，療程為14 d。入院第1、18天，採用美國國立衛生研究院卒中量錶(NIHSS)及格拉斯哥昏迷量錶(GCS)進行評分，觀察兩組體重、血紅蛋白、血清白蛋白、血清前白蛋白、轉鐵蛋白等營養情況指標以及併髮癥的髮生情況。結果兩組入院第1天的體重、血紅蛋白、血清白蛋白、血清前白蛋白、轉鐵蛋白水平組間比較，差異無統計學意義(P>0.05)。 SEN組與PN組入院第18天的體重[(54.3±5.2)比(50.8±4.9)kg]、血紅蛋白[(115.6±12.1)比(104.7±10.5)g/L]、血清白蛋白[(32.2±3.3)比(29.3±3.0)g/L]、血清前白蛋白[(193.4±15.5)比(167.2±13.5)mg/L]、轉鐵蛋白[(2.29±0.62)比(1.73±0.46)g/L]組間比較，差異均有統計學意義(均P<0.05)。兩組入院第1、18天的NIHSS評分組間比較差異無統計學意義(P>0.05)；兩組入院第18天的NIHSS評分與入院第1天比較，差異無統計學意義(P>0.05)。 SEN組入院第18天的GCS評分高于入院第1天[(8.32±1.47)比(6.45±1.39)分，P<0.05]及PN組[(8.32±1.47)比(6.72±1.84)分，P<0.05)]，差異有統計學意義。SEN組的胃齣血、肺部感染、腸源性感染髮生率低于PN組(14.04%比33.33%，19.30%比35.29%，7.02%比17.65%，均 P<0.05)。結論早期閤理的腸內營養支持可為重癥腦齣血患者提供全麵營養，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：비교서관성장내영양(SEN)여장외영양(PN)재중증뇌출혈환자치료중적응용효과。방법회고성분석북경천단의원급진ICU우2009년8월~2011년9월수치적중증뇌출혈환자808례적림상자료。근거본연구설계적병례입선표준수궤추취108례환자납입연구，근거치료방법불동，장저사환자분위량조：SEN조(n =57)급PN조(n=51)。 SEN조재입원제1천개시급여장내영양혼현액(SP)，2~3 d후여이장내영양혼현액(TPF)；PN조여이등열잡적지방유안기산(17)포도당(11%)주사액，료정위14 d。입원제1、18천，채용미국국립위생연구원졸중량표(NIHSS)급격랍사가혼미량표(GCS)진행평분，관찰량조체중、혈홍단백、혈청백단백、혈청전백단백、전철단백등영양정황지표이급병발증적발생정황。결과량조입원제1천적체중、혈홍단백、혈청백단백、혈청전백단백、전철단백수평조간비교，차이무통계학의의(P>0.05)。 SEN조여PN조입원제18천적체중[(54.3±5.2)비(50.8±4.9)kg]、혈홍단백[(115.6±12.1)비(104.7±10.5)g/L]、혈청백단백[(32.2±3.3)비(29.3±3.0)g/L]、혈청전백단백[(193.4±15.5)비(167.2±13.5)mg/L]、전철단백[(2.29±0.62)비(1.73±0.46)g/L]조간비교，차이균유통계학의의(균P<0.05)。량조입원제1、18천적NIHSS평분조간비교차이무통계학의의(P>0.05)；량조입원제18천적NIHSS평분여입원제1천비교，차이무통계학의의(P>0.05)。 SEN조입원제18천적GCS평분고우입원제1천[(8.32±1.47)비(6.45±1.39)분，P<0.05]급PN조[(8.32±1.47)비(6.72±1.84)분，P<0.05)]，차이유통계학의의。SEN조적위출혈、폐부감염、장원성감염발생솔저우PN조(14.04%비33.33%，19.30%비35.29%，7.02%비17.65%，균 P<0.05)。결론조기합리적장내영양지지가위중증뇌출혈환자제공전면영양，증강궤체저항력，강저병발증발생솔，대개선예후유중요적림상개치。
Objective To compare application effect of sequential enteral nutrition (SEN) and parenteral nutrition (PN) in the treatment of patients with severe cerebral hemorrhage. Methods Clinical data of 808 patients with severe cere-bral hemorrhage treated at Emergency Department ICU of Beijing Tiantan Hospital from August 2009 to September 2011 were retrospectively analyzed. 108 patients were selected randomly according to the design of this study. All pa-tients were divided into two groups:SEN group (n=57) and PN group (n= 51) according to the different therapy. SEN group received enteral nutritional suspension (SP) from the first day after admission, 2 to 3 days later, and received en-teral nutritional suspension (TPF);while PN group received Kabiven parenteral nutrition therapy through central venous catheterization, treatment for 14 days. On the first and eighteen day after admission, National Institutes of Health stroke scale (NIHSS) and Glasgow coma scale (GCS) were used to test neurological score. Nutritional indexes (body weight, hemoglobin, serum albumin, serum pro-albumin, transferrin) and complication between two groups were observed. Results On the first day after admission, there were no significant differences in body weight, hemoglobin, serum albumin, serum pro-albumin, transferrin level between two groups (P> 0.05). On the eighteen day after admission, body weight [(54.3±5.2) v s (50.8±4.9) kg], hemoglobin[(115.6±12.1) v s (104.7±10.5) g/L], serum albumin [(32.2±3.3) v s (29.3±3.0) g/L], serum pro-albumin [(193.4±15.5) v s (167.2±13.5) mg/L], transferrin [(2.29±0.62) v s (1.73±0.46) g/L] between SEN group and PN group was compared respectively, with statistical difference (all P<0.05). On the first and eighteen day after admission, NIHSS score between two groups was compared respec-tively, with no statistical difference (P > 0.05). Com-pared with on the first day after admission, NIHSS scores between two groups on the eighteen day after admission had no statistical difference (P>0.05). On the eighteen day after admission, GCS score of SEN group was higher than that on the first day after admission [(8.32±1.47) v s (6.45±1.39) scores, P<0.05] and PN group [(8.32±1.47) v s (6.72±1.84) scores, P<0.05], with statistical difference. Incidence rate of stomach bleeding, lung infection, enterogenic infection in SEN group was lower than that in PN group respectively (14.04%vs 33.33%, 19.30%vs 35.29%, 7.02%vs 17.65%, all P< 0.05). Conclusion Early and reasonable enteral nutrition support way for patients with severe cerebral hemorrhage can provide comprehensive nutrition, enhance their body resistance, reduce incidence of complication, and create an important clinical value for improving prognosis.