摘要
目的探讨亚甲蓝排泄试验在重型颅脑损伤患者早期实施合理营养支持中的应用价值。方法将2010年1月至2012年6月入院的133例重型颅脑损伤患者作为治疗组，将2007年1月至2009年12月入院的同类患者127例作为对照组。治疗组患者于受伤第3、8、15天进行亚甲蓝排泄试验，根据患者尿液变蓝色的时间确定营养支持方式；对照组常规先采用肠内营养支持治疗，15d后仍不能耐受肠内营养者改为肠外营养治疗。观察两组患者体质量、血清白蛋白及血红蛋白等营养情况以及并发症的发生情况。伤后3个月随访格拉斯哥预后评分（GOS）情况判断疗效。结果治疗前两组体质量差异无统计学意义，3周后治疗组平均体质量为（56．3±5．5）kg，对照组为（52．6±5．3）蝇，两组比较差异有统计学意义（t=5．93，P〈0．01）；伤后第14、21天治疗组的血清白蛋白分别为（32．7±3．4）、（34．3±3．8）g/L，血红蛋白为（113．4±12．5）、（118．5±13．3）g/L，对照组分别为（28．8±3．1）、（30．7±3．3）g／L，（102．2±11．6）、（106．7±12．4）g／L，治疗组营养状态明显优于对照组（P均〈0．05）；3个月后治疗组有效率为93．23％（124／133），对照组为84．25％（107／127），差异有统计学意义（x2=5．29，P〈0．05）。结论根据亚甲蓝排泄试验来确定重型颅脑损伤患者早期合理营养支持方式，可为患者合理提供全面营养，增强机体抵抗力，降低并发症发生率，对改善预后有重要的临床价值。
Objective To investigate the application value of methylene blue excretion test in early reasonable nutritional support for severe traumatic brain injury. Methods One hundred and thirty-three cases of severe traumatic brain injury admitted to hospital from January 2010 to June 2012 were chosen as treatment group, while the 127 cases of similar patients admitted to hospital from January 2007 to December 2009 were chosen as control group. Patients in treatment group underwent methylene blue excretion test in 3 days, 8 days, 15 days after injury, and the nutritional support ways were determined according to the elimination time of methylene blue in patients＇ urine. The control group conventionally receive enteral nutrition support therapy firstly, after 15 days if they still cannot be tolerant of the enteral nutrition, then parenteral nutrition therapy were adopted. The weight, serum albumin and hemoglobin circumstances of the two groups were determined and the complications were recorded. Glasgow coma score （GCS） of 3 months after injury were followed up. Results There was no significant difference on the average body weigh between these two groups before treatment. The average body weight of the treatment group was significantly higher than that of control group after 3 months treatment（ （56. 3 ± 5.5 ） kg vs. （52. 6 ± 5.3 ） kg, t = 5.93, P 〈 0. 01 ）. The serum albumin and hemoglobin of 14 d, 21 d after injury were significantly higher than those of the control group （serum albumin of 14 d： （32.7±3.4） g/Lvs. （28.8±3.1） g/L; serum albumin of 21 d： （34.3±3.8） g/Lvs. （30.7±3.3） g/L; hemoglobin of 14 d： （113.4±12.5） g/L vs. （102.2 ±11.6） g/L;hemoglobin of 21 d：（118.5 ±13.3） g/L vs. （106. 7 ± 12. 4） g/L. Nutritional status of treatment group was significantly better than that of the control groupall P 〈 0.05 ）. After three months, the effective rate of treatment group （93.23% （124/133）） was significantly higher than that of the control g
出处
《中国综合临床》
2013年第9期956-960,共5页
Clinical Medicine of China
关键词
重型颅脑损伤
亚甲蓝排泄试验
肠内营养
肠外营养
Severe traumatic brain injury
Methylene blue excretion test
Enteral nutrition
Parenteral nutrition
