A Comparative Study Of Combined Nutrition And Simple Enteral Nutrition In The Early Stage Of Neurosurgery

Objective To explore clinical efficacy of early combined application of parenteral nutrition and enteral nutrition among patients in neurosurgical intensive care unit(NICU).Methods Two hundred fifty five patients with severe neurological diseases were admitted to NICU of Shanghai Tenth People's Hospital were divided into group of traditional enteral nutrition and group of early combined application of parenteral and enteral nutrition from January 1 to August 31 in 2018.The patients in the former group were treated with enteral nutrition management at the early stage,while the patients in the latter group were at first treated with parenteral nutrition since admission and then enteral nutrition management 72 hours later.The differences of Glasgow outcome scale(GOS),incidence of individual adverse reactions,daily average enteral nutrition,human albumin supplement,daily average fluid supplement,pulmonary infection rate,infection time and albumin level during hospitalization between the two groups were compared.The relationship among the course of enteral nutrition,nutrient content,pulmonary infection and serum albumin level in combined nutrition group was also discussed.The GOS was predicted by decision tree,random forests,nearest neighbor algorithm,adaboost and bagging.Results A total of 255 patients were enrolled.The proportion of the traditional nutrition group was 66.7%,and the early combined nutrition group accounted for 33.3%.There was no significant difference between baseline scores after 1:2 propensity score matching.The dominance ratio of GOS between the two groups was 1.853(1.018-3.385),and P value was 0.043.The change of albumin level was not related to the choice of nutritional regimen,but was related to the level of consciousness after admission and the level of basic albumin before admission.The level of consciousness in the experimental group was higher than that of the control group,and the fluid infusion volume was decreased while the daily average enteral nutrition and albumin supplementation were increased,the types of adverse reactions were more diverse and the time point of occurrence was earlier(P < 0.05).The misleading rate of each GOS prediction model is between 0.482 and 0.606.Conclusions Compared with traditional early enteral nutrition therapy,early combined parenteral nutrition and enteral nutition can improve the prognosis of severe neurological patients.