延髓性麻痹患者营养评估对鼻饲的指导意义

Significance and efficacy of nutrition estimating used for nasal-feeding guiding in brain apoplexy patients with glossopharyngeal paralysis

目的探讨早期营养评估对脑卒中延髓性麻痹患者鼻饲的指导意义。方法用体重指数(BMI)、血清白蛋白(ALB)指标将患者分为营养正常组和营养不良组。每组各设治疗组和对照组,观察各组患者治疗前后神经功能缺损评分及常见并发症的发生率。结果经10d治疗后,营养正常组中治疗组与对照组的神经功能缺损评分及肺部感染、压疮等并发症的发生率相比无明显改善(P>0.05),而水电解质紊乱发生率明显下降(P<0.05)。营养不良组中治疗组神经功能缺损评分相比对照组有明显改善(P<0.05),且肺部感染、水电解质紊乱、压疮等并发症的发生率明显降低(P<0.05)。结论早期对患者进行营养评估,如营养不良应尽早予鼻饲加强支持治疗;如营养正常可不予鼻饲,但需监测水电解质情况,及时纠正水电解质紊乱。

Objective To evaluate the significance and efficacy of early phase nutrition estimating used for nasal-feeding guiding in brain apoplexy patients with glossopharyngeal paralysis. Methods The patients were assigned into cachexia group and normal nutrition group based on the body mass index(BMI)and serum albumin(ALB),and each group was divided into nasal-feeding subgroup(therapeutic subgroup) and non-nasal-feeding subgroup(control subgroup).The main outcome measures included neurologic function impairment score and incidence rates of the common complications after treatment.Results After treated for ten days,in normal nutrition group,there was no statistically significant difference between the therapeutic subgroup and control subgroup in neurologic function impairment score and the incidence rate of complications such as pulmonary infection and decubitus ulcer(P>0.05).But electrolyte disturbances decreased obviously(P<0.05).In the cachexia group,compared with the control subgroup,much better neurologic function impairment scores were obtained(P<0.05),and less complications occurred(P<0.05) in the therapeutic subgroup. Conclusion For the patient with cacotrophia nose fodder sharpening support should be applied as early as possible while for the patient without cacotrophia nasal-feeding is not necessary to provide and the electrolyte is monitored and kept in a normal range.