Risk Assessment And Countermeasures Of Nutritional Support In Patients With Severe Craniocerebral Injury

Severe craniocerebral injury patients due to acute stress leads to a series of metabolic reactions,mainly high catabolism,energy consumption,high blood sugar,a lot of changes to increase muscle tissue consumption,gastrointestinal function,decreased body resistance as the main pathological change,the body and disease associated with systemic inflammation and the reaction degree of partial and general illness is more serious and more serious inflammation reaction.In addition,mediators of inflammation,such as cytokines,often lead to secondary neurological damage and the involvement of the body,leading to dysfunction.Affected by the brain damage,dysphagia and other factors,the patient can not eat,nutrition support.The early stage of acute brain injury,the patients with gastroparesis,problems and difficulty eating disorder of consciousness is difficult to implement oral gastrointestinal nutrition method,once for a long time,in favor of early implementation of "total parenteral nutrition(parenteral)(TPN)".In recent years,the understanding of the theory of gastrointestinal nutrition,improve gastrointestinal nutrition method,especially the enterogenic infection,and other metabolic complications such as high blood glucose,intravenous nutrition caused by catheter infection,gastrointestinal nutrition especially early gastrointestinal nutrition more and more attention.At present,severe acute brain injury,especially the common clinical severe brain injury after operation can survive in patients with early gastrointestinal nutrition research is lack of system of metabolism,especially glucose metabolism in short and long-term impact on patient data.On the basis of nutritional risk assessment,prospective study of early enteral nutrition for severe brain injury and improve the prognosis after operation.To investigate the changes and mechanism of early enteral nutrition after brain injury,and to provide the data for itsclinical application.Methods: 244 hospitalized patients with severe brain injury.Female 48 cases,male196 cases,GCS 6~8 score,the patients in 16~50 years old.All patients underwent surgery within 6 hours after admission and were randomly divided into three groups: EEN group(TPN group)and early enteral nutrition group(group a).There was no significant difference between the three groups in average height,age,weight,GCS score,treatment and injury types.And the use of nutritional risk composite index screening tool evaluation.Three groupsup with nutritional support were started in 48 hours after the surgery,group TPN intravenous parenteral nutrition;EN group at intervals of every 4 hours of tube feeding diet factors,2 weeks after injury for homogenized diet diet changes gradually;group EEN patients received nasogastric tube 24 hour continuous infusion of American production,Abbott Company(ENSURE).The end of the study was 28 days after operation,and the time from the discharge to the hospital was about 15 years after injury.Results: The incidence rate of reflux,incidence of aspiration pneumonia and upper gastrointestinal bleeding were higher than those in the other two groups.The GCS score6-8 points in the three groups after injury 2 weeks for the negative nitrogen balance,1weeks after injury,the nitrogen balance in the EEN group-2.19 + 2.36-6.86 + 2.82 is better than that of EN group and TPN group(P=0.0112-7.20 + 3.33)?Serum albumin was consistently low after surgery,and there was no significant difference between the three groups during the study period.Creatinine height index(ICr)showed a downward trend,but the patients in group EEN were significantly better than those in the other two groups at day 14 and day 28(P<0.05).The majority of patients with nutritional index EEN group was significantly better than the other two groups(P<0.05),GCS score was significantly higher than the TPN group and the traditional group(P<0.05).after 2 weeks in two groups of patients were negative nitrogen balance,EEN group of patients after 6 days in the 24 hour output of nitrogen was higher than that in group TPN patients,so that patients of the EEN group after 6 days of nitrogen balance better than those in group TPN(P<0.05).Postoperative serum albumin was low,and there was no significant difference between the two groups during the study.Creatinine height index(ICr)showed a downward trend,butthe patients in group EEN were significantly better than those in group TPN at 14 and 28 days after surgery(P<0.05).The majority of nutritional indicators EEN group was significantly better than TPN group(P<0.05),GCS score was significantly higher than those in group TPN(P<0.05).3 months after surgery,three groups of average morning fasting glucose level in the normal range,In the first year after injury,the GCS score of the patients in the 6-8 group was higher than that of the early morning fasting blood glucose level of 7.8 mmol/L in the study group,and there was no statistical difference between the three groups(P>0.05).i Fifth years,the morning fasting blood glucose levels higher than the case of mmol/L,TPN()was significantly higher than the group EN(12/40)in the group of 9.86%(6/61)and EEN group of 10.41%(5/48).There was no significant difference in survival between the three groups.Three groups of patients with multiple indicators of nutritional assessment tools to assess the risk of malnutrition after severe traumatic brain injury,showed no difference between the three groups of high-risk.NRI predicts the occurrence of malnutrition after injury,and the risk of malnutrition in early enteral nutrition support of 2.45 + and TPN2.25 + 0.65 is less than that of conventional nasal feeding(+)(2.05)(P=0.043).The results of the risk assessment of severe craniocerebral injury of the nutritional support ways and methods of implementation of the medical staff,to participate in the study of the diagnosis and treatment of cases,clinical staff interviews show that the method of EEN,the operation is convenient,the amount of labor,daily work,the minimum impact score is beneficial in patients with the highest,EN is the best in terms of the cost evaluation but,that will increase the burden and workload of nurses.For TPN,health care professionals believe that the cost is significantly increased,not beneficial for patients.Conclusion: the patients with severe brain injury and early postoperative enteral nutrition support can not only avoid the TPN patients with high blood glucose metabolic complications,but also maintain the structure and function of gastrointestinal tract,reduce postoperative hypermetabolism,reduce intestinal ischemia reperfusion injury,reduce the decomposition of body muscle tissue,reduce the stress response after injury,not only toimprove the intensive the recovery of neural function after brain injury and the nutritional status of the body be of great advantage,at the same time,the early application of enteral nutrition may help to maintain metabolic function,reduce the risk of diabetes in patients with long-term.Severe craniocerebral injury patients with malnutrition risk assessment,can use complex tools for assessment of nutritional risk and nutritional risk index(NRI)and NRS2002 which is composed of clinical nurses,dietitians to determine the need for the formulation and implementation of parenteral or enteral nutrition support program,has a certain clinical significance.