Clinical observation on application of different enteral nutrition preparations in patients with severe traumatic brain injury / 中华危重病急救医学

ABSTRACT

Objective? To?observe?the?effects?of?enteral?nutrition?(EN)?emulsion?with?different?components?on?nutritional?index,?blood?glucose,?inflammatory?reaction,?gastrointestinal?tolerance?and?prognosis?in?patients?with?severe?traumatic?brain?injury?(sTBI).? Methods? Patients?with?sTBI?[Glasgow?coma?scale?(GCS)?<?8]?admitted?to?intensive?care?unit?(ICU)?of?Affiliated?Hospital?of?Guizhou?Medical?University?from?January?2016?to?May?2018?were?retrospectively?analyzed.?These?patients?had?received?EN,?30?cases?of?them?were?fed?with?Baipuli,?35?cases?were?fed?with?Ruineng,?and?30?cases?were?fed?with?Ruisu.?The?EN?support?began?within?48?hours?after?the?patients?were?transferred?to?ICU,?and?the?energy?intake?of?83.68-104.60?kJ·kg-1·d-1?was?the?nutritional?support?target.?The?hemoglobin?(Hb),?lymphocyte?count?(LYM),?serum?albumin?(Alb),?pre-albumin?(PA),?procalcitonin?(PCT),?average?blood?glucose?(GLUave)?and?blood?glucose?variation?coefficient?(GLUcv)?were?observed?7?days?after?EN?support,?EN?compliance?time,?gastrointestinal?tolerance?situations?were?recorded,?and?the?duration?of?mechanical?ventilation?(MV),?the?length?of?ICU?stay?and?incidence?of?nosocomial?infection?were?compared?among?the?three?groups.? Results? There?were?no?obvious?changes?in?Hb,?LYM,?Alb,?PCT?among?three?groups?after?treatment?on?the?7th?day,?and?there?was?no?significant?difference?among?the?three?groups.?The?PA?of?Baipuli?group?was?significantly?higher?than?that?in?Ruineng?and?Ruisu?groups?at?7?days?after?treatment?(mg/L:?275.55±46.18?vs.?238.25±49.59,?240.70±55.59,?both?P?<?0.05),?but?the?GLUave?and?GLUcv?were?much?higher?than?those?in?Ruineng?and?Ruisu?groups?[GLUave?(mmol/L):?10.02±2.39?vs.?8.53±1.53,?8.98±1.75;?GLUcv:? (23.59±3.93)%?vs.?(14.79±3.65)%,?(17.88±2.90)%,?all?P?<?0.05].?The?indexes?of?gastrointestinal?tolerance?in?Baipuli?group?were?better?than?those?of?Ruineng?and?Ruisu?groups:?the?target?feeding?time?was?reached?ahead?(days:?4.40±1.20?vs.?5.50±1.07,?5.45±1.02,?both?P?<?0.05),?the?incidence?of?gastric?retention?and?digestive?tract?hemorrhage?were?both?decreased?[6.67%?(2/30)?vs.?31.43%?(11/35),?33.33%?(10/30);?3.33%?(1/30)?vs.?14.29%?(5/35),?16.67%?(5/30),?all?P?<?0.05].?The?duration?of?MV?and?the?length?of?ICU?stay?in?Ruisu?and?Baipuli?groups?were?longer?than?those?of?Ruineng??group?[duration?of?MV?(days):?6.94±1.64,?6.79±1.14?vs.?5.93±1.12;?the?length?of?ICU?stay?(days):?9.40±2.18,?10.40±2.35?vs.?7.45±1.83,?all?P?<?0.05].?There?was?no?significant?difference?in?the?incidences?of?nosocomial?infection?among?Ruineng,?Ruisu,?and??Baipuli?groups?[the?incidence?of?ventilator-associated?pneumonia?(VAP):?11.43%,?10.00%,?10.00%;?catheter?related?bloodstream?infection:?0,?0,?3.33%;?urinary?tract?infection:?5.71%,?6.67%,?6.67%;?intracranial?infection:?2.86%,?6.67%,?3.33%,?all?P?>?0.05].? Conclusion? For?patients?with?sTBI,?short?peptide?EN?preparations?(Baipuli)?is?much?better?in?gastrointestinal?tolerance?but?it?can?cause?fluctuations?of?blood?glucose;?the?whole?protein?EN?containing?ω-3?fatty?acid?(Ruineng,?Ruisu)?has?relatively?less?fluctuation?on?blood?glucose,?the?duration?of?MV?and?the?length?of?ICU?stay?can?be?shortened?by?Ruineng,?therefore?it?is?more?suitable?to?be?applied?for?such?patients.