摘要目的 探讨重型颅脑损伤(STBI)患者超早期进行胃肠功能干预和早期实施持续肠内营养支持治疗的I晦床效果及对降低MODS发生率和死亡率的意义.方法 将符合条件的62例STBI患者随机分为干预组32例和对照组30例.常规治疗同时,干预组还给予超早期(伤后6 h)经鼻胃管行间断胃肠减压及鼻饲蒙脱石+中药大黄粉干预胃肠功能,并早期(伤后24 h)经螺旋形鼻肠管持续泵注"肠内高营养多聚合剂"行肠内营养支持治疗.对照组给予H2-R阻滞剂及静脉营养支持治疗.各组伤后第1、3、7、12天行营养指标、胃液潜血检测及胃肠功能障碍评分,2周内每天行GCS和MODS评分,统计2周时MODS发生率和死亡率.结果 患者能较好的耐受早期持续肠内营养支持治疗,早期两组的营养指标无差异(P>0.05),但7 d后存在差异(P<0.05);且干预组在胃液潜血及胃肠功能障碍评分、GCS、MODS评分和死亡率方面较对照组均有显著差异(P<0.01).结论 重视STBI后超早期胃肠功能障碍干预及早期实施持续肠内营养治疗对改善机体营养不良及胃肠功能,降低MODS发生率,从而降低STBI患者死亡率有重要临床意义.

abstractsObjective To investigate the clinical results and signification of decrease in MODS incidence rate and mortality rate in gastrointestinal function when super-earlier intervened and enteral nutrition were practiced for serious brain injury patients. Methods Sixty-two patients were divided into intervene group (32 cases) and control group (30 cases) stochastically. Interrupted gastrointestinal decompression, Smecta plus Rhubarb powder and Nutrison Fibre were adopted with spiral nasointestinal tube within 24 hours after injury besides general treatment in intervene group . H2-R retarder and intravenous nutrition were adopted in control group. Index of nutrition, disturbance were detected during 1, 3, 7, 12 days, GCS and MODS were detected every day within 2 weeks after injury. MODS incidence rate and mortality rate were calculated at the fourteenth day. Results Early continually enteral nutrition support is tolerable for patients. There were no differences in index of nutrition within 7 days (P>0.05), but distinguished difference can be seen after 7 days(P<0.05). Distinguished differences can be found in gastric juice occult blood, gastrointestinal dysfunctional scale, GCS, MODS and mortality rate(P<0.01). Conclusion Super-earlier gastrointestinal function intervene and early continually enteral nutrition were important to improve gastrointestinal function, amelioration dystrophy, decrease MODS incidence rate and mortality rate after STBI.