| Background : Patients with acute cerebral apoplexy require nutritional support becease of an accelerated metabolism and prolonged inability to eat. Because of unconsciousness , hypoalimentation , the high incedence of gastropareis, enteral nutritional support of patient with acute head injury has traditionally been difficult and let to frequentuse of total parenteral nutrition (TPN). In recent years, recognizing the advantage of enteral feeding and complications of metalolism indcued by TPN, the enteral nutrition, in especial early enteral feeding, has been paid much attention to the treatment of severe head injury. To date, it shows lack of objective and serial data about clinical study of early enteral feeding post acute apoplexy stroke, especially, hypertension cerebral hemorrhage (HICH) . This pospect study evaduats that tolerance of modified nasogastric feeding as early nutritional support, attempts to appraise the mechanism and clinical effect of early enteral feeding, versus TPN with equivalent caloric and nitrogen intake, on improving outcome, nutritional state, modulating hypermetabolism and maintaining gut functions in HICH patients.Methods: 36 cases were collected, male 29, female 7, age 57~78yrs, GCS score 6~11. All the patients were admitted operation within 6hrs, and divided randomly into early enteral feeding group (EEFg), and total parenteral nutrition group (TPNg). There were no significant difference in age, GCS score, bodyweight, type of neurological in jury, and associated treatment. Nutritional support of two groups of patients were started within 48 hrs post injury, ENSURE (ABBOTT LABORATORIES, America) was supplemented by nose-gastide tube feeding within 48 hrs postin jury in EENg. Patients were studied from hospital admission to 28 days postin jury.Results: Positive nitrogen balance is not achieved in two groups during 2 wks postinjury, the 24 hrs total nitrogen loss in EENg decreased more than that of TPNg on 6 days postinjury (P＜0. 05), EENg had greater cumulative nitrogen balances compared with the TPNg on 6 days postinjury (P＜0. 05) . Serum albumin was well maitained at mild levels of "depletion", and there were notsignificantly between two groups. The trend of the ICr is about the same, TPNg on 14, 28 days postinjury is signifcantly lower than those of EENg (P＜0.05) .Serum glucose, Insulin and cortisol are increased postinjury(P＜0. 05-0.01). Hyperglycemia of two groups were to peak on 6 day postinjury. At this time, Serum glucose, Insulin in EENg is significantly lower than that of TPNg (P＜0. 05) . Cortisol on EENg is much lower than TPNg at most timepoints (P＜0. 05-0.01), relapse to normal range, but that of TPNg is anomaly.As compare with TPNg, *** of EENg were not increased during 6 days postinjury (p＜0. 05~P0. 01). However, controlled study demonstrated a reduction in gastric bleeding, *, diarrhea, constipation and* with early enteral feeding(P＜0. 05). On 4 wks postinjury, EENg lost a mean weight 4.73 kg, TPNg lost 6.24 kg (P＜0. 05), most of the nutritional appraisal of EENg are significantly better than those of TPNg (P＜0. 05), GCS score in EENg was noted to be higher inTPNg (P＜0. 05).Conclusion: Evidence indicates that aggressive early enteral feeding regnimens using small nasogastric tude are tolerared better than previously believed. It is indicated that the early enteral feeding not only could effectively avoid hyerglycemia of TPN, but also lessen massive loss of lean body mass and preserve bodyweight. It is suggested that the early nutrition reduced hypermetabolism were by means of decreasing the level of mediator such as catablic hormone in blood stream, and was noticely associated with a lower incidence of the gut reperfusion injury, assertting, gastric-intestinal structure and function. The optimal enteral nutritional support can improve the whole nutrition state and be beneficial to neurologic recovery following head injury. |
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