Investigation On Nutritional Status Of Critically Ill Patients In Department Of Cerebral' Surgery Of A Two Grade Hospital In Nanjing

Objective1.To understand the application of nutritional therapy in critically ill patients of the department of cerebral surgery.2.To observe the anthropometric indicators,biochemical indicators and the incidence of complications of the patients without and with nutritional treatment,to understand the nutritional status of patients without and with nutritional treatment.Contents and methodsObject of investigation:Critically ill patients who treated in the department of cerebral surgery of a secondary hospital in Nanjing from June 2014 to May 2015 are selected as the object of investigation.According to the inclusion and exclusion criteria,143 patients are included in this survey,and 95 cases of them are male,48 cases are female.Research tool and contents:"Nutritional therapy status questionnaire for critically ill patients of the department of cerebral surgery",which proposed by Xiao Jianhui according to the relevant situation of Hunan province nutritional support treatment status investigation report,is selected as the research tool.The contents on general data,nutritional treatment during hospitalization,nutritional status,complications during hospitalization,and prognosis of diseases in 28 days for patients are studied.Measurements of relevant indicators:Measurements of the general data and relevant indicators of patients are completed within 24 hours of admission.The measurements of relevant indicators for patients within 24 hours of admission,hospitalization for 10 days,hospitalization for 21 days respectively are as following:weight,body mass index(BMI),triceps skinfold thickness(TSF),arm muscle circumference(AMC)and clinical biochemical indicator which includes total lymphocyte(TLC)and serum albumin(ALB).Result:1.143 cases of critically ill patients of the department of cerebral surgery are selected into the survey sequence.Most of these patients are young adults,and the average age is 48.31 ± 15.77 years old.Among them,95 cases are male,and 48 cases are female.On admission,the body mass index was 22.61±3.63;NRS2002 disease severity score was greater than 3 points.Reasons for hospitalization are as follows:car accident(64.34%)are 92 cases,height falling are 26 cases(18.18%),heavy hit are 16 cases(11.19%),and careless fall are 9 cases(6.29%).Admission diagnosis results are as follows:Subdural hematomas are 29 cases(20.28%),epidural hematomas are 34 cases(23.78%),cerebral contusions and lacerations are 42 cases(29.37%),intracranial hematomas are 11 cases(7.69%),primary brain stem injuries are 13 cases(9.09%),and hematomas are 14 cases(9.79%).The average hospitalization days are 22.87±9.89 days,and mortality rate of 28 days is 11.19%(16 cases).2.The patients are fasted in the first 48 hours after in hospital.TPN(total parenteral nutrition support therapy)adjuvant therapy is adopted for the patients according the clinical situations.Two kinds of nutritional treatment programs are used for the patients after 48 hours in hospital as follows:the TEN nutritional supports and EN combined with PN nutritional supports.The former program is adopted for 97 cases(67.83%),and the later program is adopted for 46 cases(32.17%).Nutrison and Baipuli are combined used as EN Nutrition preparations;fat emulsion,Kevin,human serum albumin,plasma,and the whole blood and so on are chose for PN nutritional preparations according to the situations of patients.The approach of Nasogastric tube or nasal gastric tube is selected for the support way of EN nutrition,and the transnasal approach is used by 92.31%patients to implement the EN nutrition support.Gastric residuals of the patients with EN nutrition support are monitored in this study,and the critical value of gastric residual volume is 150mL.31 patients(21.68%)are forced to interrupt EN nutrition support because of the exceeding of gastric residual volume.Among them,19 patients(61.29%)don't take gastric motility drugs.30.36%(34 patients)of the 112 patients without gastric residuals take the gastric motility drugs.The support way of EN nutrition is the approach of nasogastric tube/nasal gastric infusion tube.During hospitalization,19 patients with blood glucose fluctuations need to monitor blood glucose.Among them,EN group is 6 cases;EN+PN group is 13 cases.3.The average energy provided by EN is 52.43%of the target energy when the application of TEN nutrition support,the average energy provided by EN and PN nutritional support are respectively 35.57%and 69.85%of the target energy when the application of EN combined with PN nutritional support during hospitalization.The average protein provided by TEN is 38.47%of the target protein when the application of TEN nutritional support.The measurement of related nutritional indexes in 24 hours,10 days,and 21 days after admission for the patients are anthropometric indicators(i.e.BMI,TSF,AMC)and biochemical indicators(i.e.ALB,TLC).The results indicate that there is no significant difference between the EN group and the EN+PN group within 24 hours after admission,and no severe malnutrition cases occur.At 10th days of hospitalization,the difference between the two groups in AMC(t=2.314,p=0.024)is occurred.At the 21th days of hospitalization,the various indexes of EN group decline continually,while ALB and TLC exhibit a rising trend although the decline of TSF and AMC.The differences between two groups in TSF(t=2.328,p=0.023),AMC(t=2.368,p=0,021),ALB(t=2.412,p=0.016),TLC(t=2.335,p=0.022)are significant in statistics.There is no significant statistical difference in clinical complications and clinical outcomes between EN group and EN+PN group(i.e.p>0.05).However,the complication rate of EN group is 41.23%,and the mortality rate was 13.40%in 28 days;the complication rate of EN+PN group is 30.43%,and the mortality rate is 6.52%in 28 days.Obviously,EN group in the complications and mortality rate is significantly higher than the EN+PN group.Conclusions:The critically ill patients of cerebral surgery department are investigated in this study mostly for young adults,and male patients are more than female patients.Trauma is the main cause of the hospitalization.The hospitalization period is longer,and the mortality is higher.The nutritional support treatment of critically ill patients in the department of cerebral surgery of the hospital is paid high attention to by the clinical medical staff,and the drafting and implementation of nutrition treatment plans tend to be standardized gradually.But compared with 2009 CPG,there are still some gaps in the patient's nutritional treatment normative aspects.The timing of early enteral nutrition is not standardized,2009 CPG recommended enteral nutrition should begin within 24?48 hours after admission(recommended grade C).The EN is a lack of supply shortage and accumulated energy intake.The EN+PN group in energy supply and improving the nutritional status of the patients are better than that of the EN group.For critically ill patients,timely and adequate nutritional support is critical to the treatment and prognosis.In the case of relatively insufficient energy provided by EN,appropriate PN adjuvant treatment can ensure the supply of nutrition and energy according to the actual situation of patients,and can achieve better therapeutic effect.