Kaufman H H, Bretaudiere J P, Rowlands B J, Stein D K, Bernstein D P, Wagner K A, Gildenberg P L
Neurosurgery. 1987 Feb;20(2):254-65. doi: 10.1227/00006123-198702000-00010.
Seventy-six patients with closed head injuries alone were studied to define the relation between the severity of the head injury and secondary alterations of general metabolism. The effect of metabolic changes on neurological outcome and the importance of nutritional support on nutritional status and neurological outcome were also evaluated. Using a powerful statistical tool, convergence analysis, it was possible to take into consideration the effects of a number of confounding factors that obviously affected general metabolism. Most of the patients were hypermetabolic for prolonged periods. In addition, many did not receive even basal requirements of calories or protein for many days. Despite this, their outcomes were determined by their initial neurological status and the amounts that they were fed, admittedly relatively modest, did not influence their courses. Despite such feedings, their visceral protein levels, which often dropped initially, rose toward normal levels, indicating effective adaptation. Indeed, it could not be shown that these patients developed complications of malnutrition such as infections. However, it will require a sophisticated randomized clinical trial of vigorous intravenous hyperalimentation to determine whether this complex, dangerous, and expensive therapy is helpful for severely head-injured patients.
仅对76例闭合性颅脑损伤患者进行了研究，以确定颅脑损伤严重程度与全身代谢继发改变之间的关系。还评估了代谢变化对神经功能结局的影响以及营养支持对营养状况和神经功能结局的重要性。使用一种强大的统计工具——收敛分析，能够考虑到许多明显影响全身代谢的混杂因素的作用。大多数患者长期处于高代谢状态。此外，许多患者连续多日甚至未达到热量或蛋白质的基础需求。尽管如此，他们的结局取决于其初始神经状态，且给予他们的食物量（诚然相对较少）并未影响其病程。尽管给予了此类喂食，他们的内脏蛋白水平虽起初常常下降，但随后朝着正常水平上升，表明适应性良好。实际上，并未发现这些患者出现营养不良并发症，如感染。然而，需要开展一项精心设计的关于积极静脉高营养的随机临床试验，以确定这种复杂、危险且昂贵的治疗方法对重度颅脑损伤患者是否有益。
