摘要
目的探究重型颅脑损伤(STBI)术后营养状况并分析营养不良的影响因素。方法回顾性选取2022年2月至2024年9月东台市人民医院重症医学科收治的183例STBI手术治疗患者资料,术后2周采用主观全面评定法(SGA)评估STBI手术治疗患者的营养状况,根据评定结果将患者分为营养良好组(n=51)和营养不良组(n=132)。比较两组血清营养指标水平、临床资料,分析影响STBI患者术后营养不良相关因素。结果183例STBI手术患者中,术后2周营养良好者51例,可疑或中度营养不良者73例,重度营养不良者59例,营养不良发生率为72.13%;营养不良组血清血红蛋白、血清白蛋白,血清总蛋白水平显著低于营养良好组,差异有统计学意义(P<0.05);营养不良组年龄、手术时间、术中出血量、术后感染比例、吞咽障碍、鼻饲比例显著高于营养良好组,BMI、入院GCS评分、早期营养支持比例显著低于营养良好组,差异均有统计学意义(P<0.05);两组性别、吸烟史、饮酒史、合并症、致伤原因、脑损伤类型比较,差异无统计学意义(P>0.05);二元Logistic回归分析显示,手术时间延长、术中出血量增加、合并术后感染、吞咽障碍是影响STBI患者术后营养不良的危险因素(P<0.05),入院GCS评分升高、早期营养支持是保护因素(P<0.05)。结论STBI患者术后营养不良发生率较高,其中,手术时间延长、术中出血量增加、合并术后感染、吞咽障碍可加重患者营养不良发生风险,入院GCS评分升高、早期营养支持是患者术后营养不良的保护因素,临床上应重视对STBI患者术后营养状况的监测并及时采取措施避免营养不良的发生。
Objective To explore the nutritional status after severe traumatic brain injury(STBI)and analyze its influencing factors on malnutrition.Methods The data of 183 patients with STBI surgery in the hospital were retrospectively analyzed.At 2 weeks after surgery,the nutritional status of patients with STBI surgery was evaluated by subjective global assessment(SGA).According to the evaluation results,the patients were divided into good nutrition group(n=51)and malnutrition group(n=132),and serum nutritional indicators and clinical data were compared,and the related factors affecting postoperative malnutrition in STBI patients were analyzed.Results Among the 183 patients with STBI surgery,51 cases had good nutrition at 2 weeks after surgery,73 cases had suspected or moderate malnutrition,and 59 cases had severe malnutrition.The incidence rate of malnutrition was 72.13%.The levels of serum Hb,Alb and TP in malnutrition group were significantly lower than those in good nutrition group(P<0.05).The age,surgical time,intraoperative blood loss,proportion of postoperative infection,proportion of dysphagia and nasal feeding in malnutrition group were significantly higher(P<0.05)while the BMI,GCS score at admission and proportion of early nutritional support were significantly lower than those in good nutrition group(P<0.05).There were no obvious differences in gender,smoking history,drinking history,comorbidity,cause of injury,and type of head injury between the two groups(P>0.05).Binary Logistic regression analysis suggested that prolonged surgical time,increased intraoperative blood loss,concurrent postoperative infection and dysphagia were risk factors for postoperative malnutrition in patients with STBI(P<0.05),and increased GCS score at admission and early nutritional support were protective factors(P<0.05).Conclusions The incidence rate of postoperative malnutrition in patients with STBI is high.Prolonged surgical time,increased intraoperative blood loss,concurrent postoperative infection,and dysphagia can increase the risk of malnutrition in such patients.Increased GCS score at admission and early nutritional support are protective factors for postoperative malnutrition in such patients.Clinically,it is necessary to pay attention to the monitoring of postoperative nutritional status in patients with STBI and take timely measures to avoid the occurrence of malnutrition.
作者
柳小霞
冯波
王涔
孙小燕
许慧中
葛玲玉
姚胜红
LIU Xiaoxia;FENG Bo;WANG Cen;SUN Xiaoyan;XU Huizhong;GE Lingyu;YAO Shenghong(Department of Intensive Care Medicine,Dongtai People's Hospital,Dongtai,Jiangsu 224200,China;Department of Intensive Care Medicine,Nanjing Drum Tower Hospital,Nanjing,Jiangsu 210000,China)
出处
《中华神经外科疾病研究杂志》
2025年第3期108-112,共5页
Chinese Journal of Neurosurgical Disease Research
基金
江苏省卫生健康委科研项目(H2023025)。
关键词
重型颅脑损伤
营养不良
营养支持
影响因素分析
Severe head injury
Malnutrition
Nutritional support
Analysis of influencing factors
