早期复方高支链氨基酸联合肠内营养治疗急性重型颅脑损伤疗效观察

摘要

目的 观察早期复方高支链氨基酸联合肠内营养对急性重型颅脑损伤患者治疗效果的影响.方法 将39例急性重型颅脑损伤患者按随机数字表法分为对照组(19例)和观察组(20例).观察组和对照组患者于伤后24 ～48 h内均给予肠内营养制剂(瑞素)营养支持,观察组联合使用复方高支链氨基酸注射液(20AA),对照组联合使用普通复方氨基酸注射液(18AA).治疗7d后观察2组患者治疗后ALT、AST、血清前白蛋白、转铁蛋白的变化,以及患者感染性并发症发生率的差异.结果 治疗7d后,观察组患者ALT、AST明显低于对照组[(78±12)U/L比(96±12) U/L,(88±11)U/L比(107±14) U/L],前白蛋白明显高于对照组[(0.35±0.04)g/L比(0.31±0.03)g/L],差异均有统计学意义(均P＜0.05).观察组患者术后感染性并发症发生率低于对照组[ 30.0％ (6/20)比42.1％(8/19)],但差异无统计学意义(P＞0.05)；感染持续时间观察组明显低于对照组[(7.6±0.8)d比(8.8±1.3)d,P＜0.05].结论 与早期肠内营养联合普通复方氨基酸相比,早期复方高支链氨基酸联合肠内营养更有利于急性重型颅脑损伤患者的恢复,并能减少患者感染性并发症发生.%Objective To investigate the effects of early amino acids of high branched-chain combined enteral nutrition on patients with acute severe craniocerebral trauma.Methods Thirty-nine patients with acute severe craniocerebral trauma were randomly divided into control group (n =19)and observation group (n =20).The patients in the two groups received enteral nutrition (RuiSu)within 24 to 48 h after injury.While the patients in observation group also received high branched-chain 20AA compound amino acid injection;the patients in control group received common 18AA compound amino acid injection.The changes of ALT,AST,serum prealbumin and transferrin before and after treatment were observed,also the difference of infectious complications in two groups was observed.Results The levels of alanine aminotransferase and aspartate aminotransferase after treatment for 7 days in observation group were lower than those in control group [ (78±12 )U/L vs (96±12)U/L,(88±11 )U/L vs (107±14)U/L ];the level of serum prealbumin in observation group was higher than that in control group [(0.35±0.04)g/L vs(0.31±0.03)g/L];there was a significant difference between two groups (all P＜0.05).The incidence of infectious complications in observation group was lower than that in control group [ 30.0％ (6/20 )vs 42.1％ (8/19 )],but there was no significant difference (P ＞0.05).The duration of infection in observation group was less than that in control group [(7.6±0.8)d vs (8.8±1.3)d,P＜0.05].Conclusion Compared with early enteral nutrition combined with common 18AA compound amino acid injection,enteral nutrition combined with high branched-chain 20AA compound amino acid injection is more effective for the recovery of cellular immune function and for reducing the incidence of infectious complications in patients with acute severe craniocerebral trauma.