Function of early enteral nutrition in patients with acute gastrointestinal injury and severe craniocerebral injury

Abstract

Objective To observe the occurrence and related factors of acute gastrointestinal injury (AGI) in patients with severe craniocerebral injury, to discuss the feasibility of early enteral nutrition (EN) after AGI, and to explore the relationship between clinical outcome and early EN. Methods We collected the clinical data of 86 patients with severe craniocerebral injury, including gender, age, presence and grading of AGI, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, Glasgow coma scale (GCS), mortality, the rate of EN within 24 hours, and 7-day standard energy intake rate. The patients were divided into four groups according to AGI grading, i. e. grade Ⅰ, Ⅱ, Ⅲ, and Ⅳ, and compared in terms of gender, age, APACHE Ⅱ score, GCS, mortality, 24-hour EN rate, and 7-day standard energy intake rate. The patients were divided into two groups according to the clinical outcome (death or survival), and compared in terms of GCS, 24-hour EN rate, and 7-day standard energy intake rate. Results AGI occurred in all the 86 patients with severe craniocerebral injury, and the number of patients in grade Ⅰ, Ⅱ, Ⅲ, Ⅳ were 30, 26, 21, 9, respectively. Among the four groups according to AGI grading, there were statistical differences in APACHE Ⅱ score, GCS, and mortality (P<0.05 or P<0.01). The more severe the gastrointestinal dysfunction, the higher the APACHE Ⅱ score and mortality, and the lower the GCS score. There were statistical differences in the rate of 24-hour EN and 7-day standard energy intake rate among the four groups of AGI grading (P<0.01), with both rates decreasing with more severe gastrointestinal dysfunction. Among the two groups according to different clinical outcome, the rate of 24-hour EN, 7-day standard energy intake rate and GCS score were significantly lower in the death group than in the survival group (all P<0.01). Correlation analysis showed that there was a negative correlation between mortality and the rate of 24-hour EN (r=-0.478, P<0.01), 7-day standard energy intake (r=-0.795, P<0.01), and GCS score (r=-0.638, P<0.01). Conclusion AGI may be closely associated with severe craniocerebral injury. For patients with craniocerebral injury, especially severe injury, the gastrointestinal function should be estimated for timely application of effective nutrition support to improve patient outcome through correcting metabolic disturbance and negative nitrogen balance. Key words: Craniocerebral injury; Acute gastrointestinal injury; Mortality