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神经重症监护病房中一名创伤性脑损伤患者的肠内营养管理:病例报告

Enteral Nutrition Management in a Patient With Traumatic Brain Injury in the Neuro-Intensive Care Unit: A Case Report.

作者信息

So Eunjin, Choo Yoon-Hee

机构信息

Department of Nutrition, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea.

Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea.

出版信息

Clin Nutr Res. 2025 Jul 25;14(3):157-163. doi: 10.7762/cnr.2025.14.3.157. eCollection 2025 Jul.

Abstract

Neurocritically ill patients often encounter challenges in maintaining adequate enteral nutrition (EN) owing to metabolic disturbances associated with increased intracranial pressure, trauma, seizures, and targeted temperature management. This case report highlights the critical role of the nutrition support team (NST) in overcoming these barriers and optimizing EN delivery in a patient with traumatic brain injury (TBI). A 59-year-old man was admitted to the neuro-intensive care unit following TBI. EN was initiated early in accordance with clinical guidelines. By the time of transfer to the general ward, 82.4% of the estimated energy requirement and 102.8% of the protein requirement were met. Despite this, the patient experienced 19.4% weight loss, likely due to underestimation of hypermetabolic demands and delays in EN advancement caused by fluctuating clinical conditions. NST adjusted the nutrition strategy by incorporating high-protein formulas, parenteral nutrition supplementation, and gastrointestinal management. This case report demonstrates the importance of individualized, multidisciplinary nutritional interventions in improving clinical outcomes for neurocritically ill patients.

摘要

由于与颅内压升高、创伤、癫痫发作和目标温度管理相关的代谢紊乱,神经重症患者在维持充足的肠内营养(EN)方面常常面临挑战。本病例报告强调了营养支持团队(NST)在克服这些障碍以及优化一名创伤性脑损伤(TBI)患者的肠内营养输送方面的关键作用。一名59岁男性在创伤性脑损伤后被收入神经重症监护病房。按照临床指南早期开始肠内营养。在转至普通病房时,满足了估计能量需求的82.4%和蛋白质需求的102.8%。尽管如此,患者体重减轻了19.4%,这可能是由于对高代谢需求估计不足以及临床情况波动导致肠内营养推进延迟。营养支持团队通过采用高蛋白配方、肠外营养补充和胃肠道管理来调整营养策略。本病例报告证明了个体化、多学科营养干预对改善神经重症患者临床结局的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3432/12321491/5b52648d570e/cnr-14-157-g001.jpg

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