Objective: To observe the effects of enteral nutrition (EN) emulsion with different components on nutritional index, blood glucose, inflammatory reaction, gastrointestinal tolerance and prognosis in patients with severe traumatic brain injury (sTBI).
Methods: Patients with sTBI [Glasgow coma scale (GCS) < 8] admitted to intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2016 to May 2018 were retrospectively analyzed. These patients had received EN, 30 cases of them were fed with Baipuli, 35 cases were fed with Ruineng, and 30 cases were fed with Ruisu. The EN support began within 48 hours after the patients were transferred to ICU, and the energy intake of 83.68-104.60 kJ×kg-1×d-1 was the nutritional support target. The hemoglobin (Hb), lymphocyte count (LYM), serum albumin (Alb), pre-albumin (PA), procalcitonin (PCT), average blood glucose (GLUave) and blood glucose variation coefficient (GLUcv) were observed 7 days after EN support, EN compliance time, gastrointestinal tolerance situations were recorded, and the duration of mechanical ventilation (MV), the length of ICU stay and incidence of nosocomial infection were compared among the three groups.
Results: There were no obvious changes in Hb, LYM, Alb, PCT among three groups after treatment on the 7th day, and there was no significant difference among the three groups. The PA of Baipuli group was significantly higher than that in Ruineng and Ruisu groups at 7 days after treatment (mg/L: 275.55±46.18 vs. 238.25±49.59, 240.70±55.59, both P < 0.05), but the GLUave and GLUcv were much higher than those in Ruineng and Ruisu groups [GLUave (mmol/L): 10.02±2.39 vs. 8.53±1.53, 8.98±1.75; GLUcv: (23.59±3.93)% vs. (14.79±3.65)%, (17.88±2.90)%, all P < 0.05]. The indexes of gastrointestinal tolerance in Baipuli group were better than those of Ruineng and Ruisu groups: the target feeding time was reached ahead (days: 4.40±1.20 vs. 5.50±1.07, 5.45±1.02, both P < 0.05), the incidence of gastric retention and digestive tract hemorrhage were both decreased [6.67% (2/30) vs. 31.43% (11/35), 33.33% (10/30); 3.33% (1/30) vs. 14.29% (5/35), 16.67% (5/30), all P < 0.05]. The duration of MV and the length of ICU stay in Ruisu and Baipuli groups were longer than those of Ruineng group [duration of MV (days): 6.94±1.64, 6.79±1.14 vs. 5.93±1.12; the length of ICU stay (days): 9.40±2.18, 10.40±2.35 vs. 7.45±1.83, all P < 0.05]. There was no significant difference in the incidences of nosocomial infection among Ruineng, Ruisu, and Baipuli groups [the incidence of ventilator-associated pneumonia (VAP): 11.43%, 10.00%, 10.00%; catheter related bloodstream infection: 0, 0, 3.33%; urinary tract infection: 5.71%, 6.67%, 6.67%; intracranial infection: 2.86%, 6.67%, 3.33%, all P > 0.05].
Conclusions: For patients with sTBI, short peptide EN preparations (Baipuli) is much better in gastrointestinal tolerance but it can cause fluctuations of blood glucose; the whole protein EN containing ω-3 fatty acid (Ruineng, Ruisu) has relatively less fluctuation on blood glucose, the duration of MV and the length of ICU stay can be shortened by Ruineng, therefore it is more suitable to be applied for such patients.