Bai Lili, Feng Qingguo, Teng Hongyun, Guo Liyan, Wang Dangqing, Zhang Yuanzheng
Intensive Care Unit, Tianjin Fifth Central Hospital, Tianjin 300450, China.
Neurological Intensive Care Unit, Tianjin Fifth Central Hospital, Tianjin 300450, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Sep;36(9):985-988. doi: 10.3760/cma.j.cn121430-20240326-00283.
To investigate the effect of ultra-early enteral nutrition (UEEN) support on the prognosis of young and middle-aged postoperative patients with cerebral hemorrhage.
The clinical data of young and middle-aged patients (aged 18-59 years) admitted to Tianjin Fifth Central Hospital from January 2020 to June 2023 after surgery for intracerebral hemorrhage were retrospectively analyzed, and the general data, nutritional indexes, gastrointestinal complications, neurological function recovery and long-term prognosis of the patients were recorded. According to the time of initiation of enteral nutrition (EN) support, patients were divided into UEEN group (EN implementation within 12 hour after surgery) and early enteral nutrition (EEN) group (EN implementation within 24 to 48 hour after surgery). The differences of the above indexes between the two groups were analyzed and compared.
A total of 64 young and middle-aged postoperative patients with cerebral hemorrhage were enrolled, including 32 cases in the UEEN group and 32 cases in the EEN group. There were no significant differences in gender, age, proportion of hypertension and diabetes, Glasgow coma score (GCS) on admission and surgical methods between the two groups. In terms of nutritional indexes, serum total protein, albumin and hemoglobin levels of patients in both groups on day 7 after admission were lower than those on day 1, and higher than those on day 3, and the above indexes levels in UEEN group were significantly higher than those in EEN group on day 7 [total protein (g/L): 63.05±5.79 vs. 59.02±6.63, albumin (g/L): 40.40±5.26 vs. 37.66±4.63, hemoglobin (g/L): 133.33±12.58 vs. 123.80±22.12, all P < 0.05]. In terms of gastrointestinal complications, the incidence of stress ulcer in the UEEN group within 14 days after admission was significantly lower than that in the EEN group [12.5% (4/32) vs. 31.3% (10/32), P < 0.05], but there was no statistically significant difference in feeding intolerance symptoms between the two groups. In terms of neurological recovery and long-term prognosis, GCS scores and Barthel index scores of 14 days after admission were higher than those of 1 day after admission, but there was no statistical significance between the two groups. Six months after surgery, Glasgow outcome scale (GOS) and Barthel index score of the UEEN group were significantly higher than those of the EEN group (GOS score: 3.81±1.06 vs. 3.18±1.07, Barthel index score: 60.78±7.24 vs. 54.52±5.13, both P < 0.05).
UEEN support can improve the nutritional level of young and middle-aged postoperative patients with cerebral hemorrhage, reduce the occurrence of postoperative gastrointestinal complications, promote the recovery of neurological function, and improve the long-term prognosis.
探讨超早期肠内营养（UEEN）支持对中青年脑出血术后患者预后的影响。
回顾性分析2020年1月至2023年6月在天津市第五中心医院行脑出血手术后收治的中青年患者（年龄18 - 59岁）的临床资料，记录患者的一般资料、营养指标、胃肠道并发症、神经功能恢复情况及远期预后。根据肠内营养（EN）支持开始时间，将患者分为UEEN组（术后12小时内实施EN）和早期肠内营养（EEN）组（术后24至48小时内实施EN）。分析比较两组上述指标的差异。
共纳入64例中青年脑出血术后患者，其中UEEN组32例，EEN组32例。两组患者在性别、年龄、高血压和糖尿病比例、入院时格拉斯哥昏迷评分（GCS）及手术方式方面差异无统计学意义。在营养指标方面，两组患者入院后第7天血清总蛋白、白蛋白和血红蛋白水平均低于第1天，高于第3天，且UEEN组第七天上述指标水平显著高于EEN组[总蛋白（g/L）：63.05±5.79 vs. 59.02±6.63，白蛋白（g/L）：40.40±5.26 vs. 37.66±4.63，血红蛋白（g/L）：133.33±12.58 vs. 123.80±22.12，均P < 0.05]。在胃肠道并发症方面，UEEN组入院后14天内应激性溃疡发生率显著低于EEN组[12.5%（4/32） vs.
31.3%（10/32），P < 0.05]，但两组在喂养不耐受症状方面差异无统计学意义。在神经功能恢复及远期预后方面，入院后14天的GCS评分和Barthel指数评分高于入院后1天，但两组间差异无统计学意义。术后6个月，UEEN组格拉斯哥预后量表（GOS）评分和Barthel指数评分显著高于EEN组（GOS评分：3.81±1.06 vs. 3.18±1.07，Barthel指数评分：60.78±7.24 vs. 54.52±5.13，均P < 0.05）。
UEEN支持可提高中青年脑出血术后患者的营养水平，降低术后胃肠道并发症的发生，促进神经功能恢复，改善远期预后。
