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| The efficacy of two different nutritional methods in treatment of severe head injury |
| Li Qian-feng, Huang Qiao-chun, Huang Cong-gang, Chen Xiao-bin, Wu Jing-lei, Duan Fa-liang |
| Department of Neurosurgery, Wuhan No.1 Hospital, Wuhan 430022, China |
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Abstract Objective To explore the clinical value and curative effect of early percutaneous endoscopic gastrojejunostomy(PEG-J) in the treatment of severe head injury(SHI). Methods PEG-J in the treatment of 40 SHI cases (PEG-J tube group) and nasal gastric tube treatment of 30 SHI cases (nasal gastric tube group) clinical data were retrospectively analyzed in our department.The paralysis side of triceps skin fold (TSF), body mass index (BMI), serum albumin (propagated), hemoglobin (Hb) of the first and 21st d of enteral nutrition were compared in 2 groups;gastrointestinal dysfunction (gastrointestinal contents retention, vomiting, regurgitation, diarrhoea, constipation) and complications (mainly observe aspiration pneumonia, gastrointestinal bleeding), length of hospital stay, and Glasgow outcome score(GOS) were observed. Results The human body index and blood index of the PEG-J group ［TSF:（11.58±1.38）mm, BMI（20.51±1.50）kg/m2, Alb（40.98±4.41）g/L, Hb（113.68±21.68）g/L］ were better than that of the nasal gastric tube group［TSF（10.78±1.72）mm, BMI（19.13±1.60）kg/m2, Alb（35.00±2.36）g/L, Hb（96.37±16.24）g/L,P<0.05). The gastrointestinal dysfunction of the PEG-J group was significantly lower than that of the nasal gastric tube group (P<0.05). The complications of PEG-J group were less than that of the nasal gastric tube group, and the length of hospitalization ［(23.28±1.66)d］was less than that of the nasal gastric tube group［(27.67±2.09)d］ (P<0.05). The GOS of PEG-J group was better than that of the nasal gastric tube group (P<0.05). Conclusion PEG-J surgery is a safe, effective, less complicated operation that provides the best method for the nutritional support of the patients with SHI.
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Corresponding Authors:
Duan Fa-liang, E-mail: duanfaliang@126.com
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| ［1］Thille AW, Harrois A, Schortgen F, et al. Outcomes of extubation failure in medical intensive care unit patients［J］. Crit Care Med, 2011, 39(12): 2612-2618.
［2］Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure-a structured approach［J］. Crit Care, 2010, 14(6): 245.
［3］Bien Udos S, Souza GF, Campos ES, et al. Maximum inspiratory pressure and rapid shallow breathing index as predictors of successful ventilator weaning［J］. J Phys Ther Sci, 2015, 27(12):3723-3727.
［4］Hooijman PE, Beishuizen A, Witt CC, et al. Diaphragm muscle fiber weakness and ubiquitin-proteasome activation in critically ill patients［J］. Am J Respir Crit Care Med, 2015, 191(10): 1126-1138.
［5］Karthika M, Al Enezi FA, Pillai LV, et al. Rapid shallow breathing index［J］. Ann Thorac Med, 2016, 11(3): 167-176.
［6］Seely AJ, Bravi A, Herry C, et al. Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients［J］. Crit Care, 2014, 18(2): R65.
［7］Pirompanich P, Romsaiyut S. Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients［J］. J Intensive Care, 2018, 6: 6.
［8］Spadaro S, Grasso S, Mauri T, et al. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure The role of diaphragmatic rapid shallow breathing index［J］. Crit Care, 2016, 20(1): 305.
［9］Jeong BH, Ko MG, Nam J, et al. Differences in clinical outcomes according to weaning classifications in medical intensive care units［J］. PLoS One, 2015, 10(4): e0122 810.
［10］Kriner EJ, Shafazand S, Colice GL. The endotracheal tube cuff-leak test as a predictor for postextubation stridor［J］. Respir Care, 2005, 50(12): 1632-1638.
［11］Umbrello M, Formenti P, Longhi D, et al. Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study［J］. Crit Care, 2015, 19: 161.
［12］Macintyre NR. Evidence-based assessments in the ventilator discontinuation process［J］. Respir Care, 2012, 57(10): 1611-1618.
［13］MacIntyre NR, Cook DJ, Ely EW Jr, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine［J］. Chest, 2001, 120(6 Suppl): 375S-395S.
［14］Yan S, Lichros I, Zakynthinos S, et al. Effect of diaphragmatic fatigue on control of respiratory muscles and ventilation during CO2 rebreathing［J］. J Appl Physiol, 1993, 75(3): 1364-1370.
［15］Yan S, Sliwinski P, Gauthier AP, et al. Effect of global inspiratory muscle fatigue on ventilatory and respiratory muscle responses to CO2［J］. J Appl Physiol, 1993, 75(3): 1371-1377.
［16］Jaber S, Petrof BJ, Jung B, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans［J］. Am J Respir Crit Care Med, 2011, 183(3): 364-371.
［17］Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness［J］. N Engl J Med, 2014, 371(3): 287-288.
［18］Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans［J］. N Engl J Med, 2008, 358(13): 1327-1335.
［19］Reynolds SC, Meyyappan R, Thakkar V, et al. Mitigation of Ventilator-induced Diaphragm Atrophy by Transvenous Phrenic Nerve Stimulation［J］. Am J Respir Crit Care Med, 2017, 195(3): 339-348. |
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