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目的：探讨特重型颅脑损伤早期全肠外（ＴＰＮ）营养逐步过渡为肠内营养支持的临床意义及合理性。方法：营养组：１７例ＧＣＳ≤５分特重型颅脑损伤病人伤后２天开始应用ＴＰＮ，６～７天后根据病情逐渐给予部分肠内营养（ＥＮ）过渡，１０天后改为完全的ＥＮ。观察血糖、白蛋白、淋巴细胞计数、并发症发生率及预后。对照组：常规治疗的２０例特重型颅脑损伤作对照。结果：特重型颅脑损伤病人能从早期的ＴＰＮ中获得较充分的能量和蛋白质合成物，１周时的血糖控制程度、血浆白蛋白及外周血淋巴细胞总数优于对照组（Ｐ＜０．０５）。１周后逐渐过渡至ＥＮ更符合机体的生理要求，能保护肠粘膜屏障，使并发症减少。营养组１周后死亡率为２９％，明显低于对照组（６５％）（Ｐ＜０．０５）。结论：肠外、肠内序贯营养支持符合特重型颅脑损伤病人的病理、生理要求，能使该类病人营养状况和生存率提高。
Objective: To investigate the clinical significance and rationality of early transition of total parenteral nutrition (TPN) to enteral nutrition in patients with extra-severe traumatic brain injury. Methods: In the nutrition group, 17 cases of patients with GCS≤5 dtexes with severe craniocerebral injury started to use TPN 2 days after the injury. After 6 to 7 days, they gradually gave partial enteral nutrition (EN) transition and changed to complete EN after 10 days. Blood glucose, albumin, lymphocyte count, the incidence of complications and prognosis were observed. Control group: 20 cases of special treatment of traumatic brain injury as a control. Results: Patients with extra-severe traumatic brain injury received more energy and protein complexes from early TPN. The level of blood glucose control, total serum albumin and peripheral blood lymphocytes in 1 week were better than those in control group (P <0. 05). 1 week after gradual transition to EN more in line with the physiological requirements of the body, can protect the intestinal barrier, so that complications reduced. The mortality rate of nutrition group after one week was 29%, which was significantly lower than that of control group (65%) (P <0.05). Conclusion: Sequential nutrition support for parenteral and enteral administration conforms to the pathological and physiological requirements of patients with severe traumatic brain injury, which can improve the nutritional status and survival rate of patients with severe traumatic brain injury.