目的：探讨开始营养支持和达到完全热量摄入的时间对儿童重型颅脑外伤（TBI）患者在ICU的治疗时间和预后的影响。方法对109例入住ICU的儿童重型 TBI患者的资料进行回顾性分析。入院后开始营养支持，记录患者入IC U后的营养支持方式、开始时间和达到完全热量摄入的时间，统计分析其与患者IC U 治疗时间和预后的相关性。结果本组19例患者未开始营养支持前即死亡，余下的90例中入院后营养支持开始时间平均为（1．49±0．82）d；89例达到完全热量摄入的平均时间为（3．39±0．71）d ，在IC U的平均治疗时间为（2．09±1．01）d。本组出院时根据儿童脑功能分级量表评估，57．8％的患者恢复良好，33．3％的患者残疾，8．9％的患者死亡或昏迷状态。统计显示，入ICU后开始营养支持时间和达到完全热量摄入天数与ICU治疗天数呈正性相关（P＜0．01），开始营养支持时间和达到完全热量摄入天数越短预后越好（P＜0．05）。结论早期营养支持可缩短儿童重型 TBI患者在IC U的治疗时间和改善预后。%Objective To study the effect and timing for nutritional supplement initiation and achieving full caloric intake for treatment and outcome for patients with severe traumatic brain injury (TBI) during the stay in ICU . Method A retrospective analysis of 109 cases of children with TBI admitted to ICU was made .The nutritional sup-port way ,nutritional support start time after admission to ICU ,completely calorie intake time and days of ICU stay were recorded and compared relatively .The outcome of these patients was made on discharge according to pediatric cerebral performance category (PCPC) .The relationship between both the nutritional support start time and com-pletely calorie intake time and both days of ICU stay and outcome on discharge was analyzed .Result 19 patients died before starting nutritional support .Among the remaining 90 cases ,the average start time of nutritional support after admitting to ICU was(1 .49 ± 0 .82) days ,and completely calorie intake was achieved in 89 cases .In these 89 cases , the mean time was (3 .39 ± 0 .71) days and mean days of ICU stay was (2 .09 ± 1 .01) days .According to PCPC , 57 .8% of patients were discharged with good recovery ,33 .3% with disability and 8 .9% with coma or death .Sta-tistical analysis showed timing of start nutritional support and completely calorie intake were both positively correla-ted with days of ICU stay (P<0 .01) .And the shorter of timing of start nutritional support and completely calorie intake ,the better of outcome(P<0 .05) .Conclusion Early initiation of nutritional support may shorten the days of ICU stay and improve its outcome for child patients with severe traumatic brain injury .
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