摘要
目的：观察脑卒中合并胃潴留患者经鼻空肠管肠内营养的临床疗效。方法选择2012年3月至2015年11月河北省定兴县医院收治的42例脑卒中合并胃潴留进行肠内营养支持的患者，按随机数字表法分为观察组和对照组，每组21例。两组均按指南给予常规治疗，床头抬高30°～45°，并进行胃肠减压；观察组患者置入鼻空肠管，给予肠内营养；对照组患者先给予肠外营养，待胃肠功能恢复后改经胃管给予肠内营养。于入院时和治疗2周后取血检测两组患者血糖、血浆总蛋白和白蛋白水平；比较两组三头肌皮褶厚度（TSF）、上臂围（MAC）、上臂肌围（AMC）等评价营养状况；观察两组腹泻、应激性溃疡、胃肠道感染、反流、高血糖、中心静脉感染等不良反应和并发症发生情况。结果两组治疗前血糖、白蛋白、总蛋白水平比较差异无统计学意义（均P＞0.05）。治疗后两组血糖水平均较入院时降低，且观察组的降低更为显著（mmol/L：6.45±2.15比7.68±2.68，P＜0.05）；对照组治疗后白蛋白、总蛋白均较入院时降低，而观察组无明显变化，对照组水平明显低于观察组〔白蛋白（g/L）：30.78±4.12比38.20±4.67，总蛋白（g/L）：63.91±4.32比67.11±3.12，均P＜0.05〕。治疗2周后两组营养状况指标TSF、MAC、AMC均较入院时降低，但观察组的降低程度不及对照组显著〔TSF（mm）：11.91±1.29比10.13±1.37，MAC（cm）：24.19±3.12比23.74±2.08，AMC（cm）：22.64±2.05比21.73±2.15，均P＜0.05〕。观察组患者不良反应发生率均较对照组明显降低（腹泻：9.5%比38.1%，应激性溃疡：4.8%比33.3%，反流：4.8%比28.6%，高血糖：9.5%比38.1%，均P＜0.05）；对照组患者中心静脉感染发生率为4.8%。结论对脑卒中合并胃潴留患者行空肠内营养支持可预防营养不良的发生，降低不良反应及并发症发率，促进患者康复。
ObjectiveTo observe the clinical curative effect of nasal jejunal nutrition support in stroke patients with gastric retention.Methods Forty-two patients with cerebral apoplexy combined with gastric retention admitted to Dingxing County Hospital in Hebei province from March 2012 to November 2015 and treated with enteral nutrition support were enrolled, and they were divided into observation group and control group according to the random number table method, 21 cases in each group. Under the guidance, routine treatment were given, the head of bed was raised to 30°- 45°, and gastrointestinal decompression was carried out in the two groups. In the observation group, a nasal jejunal tube was inserted and enteral nutrition was given, while in the control group, parenteral nutrition was firstly applied until the recovery of gastrointestinal function, then nasogastric enteral nutrition was carried out. Compared between the two groups, on the day of admission before treatment and 2 weeks after treatment, blood glucose levels, plasma total protein levels, albumin were detected; the triceps skinfold thickness （TSF）, upper arm circumference （MAC）, upper arm muscle circumference （AMC）, etc were measured in the two groups to show the difference in nutritional status. Adverse reactions of diarrhea, stress ulcer, gastrointestinal tract infection, reverse flow, high blood sugar and central venous infection and complications in the two groups were observed.Results The levels of blood glucose, albumin, total protein content were not significantly different between the two groups before treatment （allP 〉 0.05）. Blood glucose levels in the two groups after treatment were lower than those on admission, and the decrease in the observation group was more significant （mmol/L： 6.45±2.15 vs. 7.68±2.68,P 〈 0.05）; the levels of albumin and total protein in the control group after treatment were lower than those on admission, while the observation group had no such significant changes, and the levels of the control group were significantly lower than those of the observation group [albumin （g/L）： 30.78±4.12 vs. 38.20±4.67, total protein （g/L）： 63.91±4.32 vs. 67.11±3.12, P 〈 0.05]. After treatment for 2 weeks, the nutritional indexes of TSF, MAC, AMC in the two groups were slightly lower than those on admission, but the degrees of descent in observation group were not as significant as those in the control group [TSF （mm）： 11.91±1.29 vs. 10.13±1.37, MAC （cm）： 24.19±3.12 vs. 23.74±2.08, AMC （cm）： 22.64±2.05 vs. 21.73±2.15, allP 〈 0.05]. The incidences of adverse reactions and complications in the observation group were significantly lower than those in the control group [diarrhea： 9.5% vs. 38.1%, stress ulcer： 4.8% vs. 33.3%, regurgitation：4.8% vs. 28.6%, hyperglycemia： 9.5% vs. 38.5%,P 〈 0.05]; In the control group, the incidence of central venous infection was 4.8%.Conclusions Gastric jejunal nutrition support in patients with cerebral apoplexy combined with gastric retention can prevent occurrence of malnutrition, reduce the incidences of adverse reactions and complications and promote the rehabilitation of patients.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2016年第5期536-538,共3页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
关键词
脑卒中
胃潴留
肠内营养支持
并发症
Cerebral apoplexy
Gastric retention
Enteral nutrition support
Complication
