鼻饲营养对伴高血糖的颅脑损伤恢复期患者生活质量的影响

Effect of tube feeding nutrition on the quality of life in patients with hyperglycemia after craniocerebral injury at the recovery phase

目的:观察合理的肠内营养支持对颅脑损伤伴高血糖的恢复期鼻饲患者各项营养指标、日常生活活动(ADL)能力的影响,并探讨营养制剂各营养成分合理的比例。方法:中国医科大学神经内、外科收治的颅脑损伤伴高血糖的恢复期鼻饲患者68例,符合1995年全国第四届脑血管病诊断要点,经颅脑CT或MRI证实,血糖6.7～17.5mmol/L,既往无营养障碍或吞咽困难病史。将68例随机分为对照组和研究组,采用间隙喂饲法,分别经鼻胃管推注两种不同的肠内营养制剂(安素益力佳和安素),观察两组患者ADL、意识、吞咽障碍的恢复情况、营养指标及血糖的变化,并对意识恢复者的进行评定。结果:经过3周的营养支持,研究组中意识障碍、吞咽障碍人数较对照组明显减少(P<0.05),各项ADL评分明显改善(P<0.05或P<0.01),ADL总评分为63.2±19.8,血糖水平较治疗前和对照组明显下降(P<0.01),由治疗前的(10.0±2.4)mmol/L降至(8.2±2.4)mmol/L。对照组血糖略有升高,但与治疗前相比差异无显著性意义(P>0.05),其ADL总评分为48.5±18.2,明显低于研究组(P<0.05)。两组患者的血浆总蛋白、清蛋白均较实验前明显上升(P<0.05),但上臂围、肱三头肌皮褶厚度无明显变化(P>0.05)。结论:高脂肪、低碳水化合物、高纤维膳食能有效降低颅脑损伤伴高血糖患者的血糖水平,改善?

AIM:To explore the influence of reasonable internal nutrition on the nutritional indexes and activities of daily life(ADL)in patients with hyperglycemia after craniocerebral injury at the recovery phase receiving tube feeding,and to explore the reasonable proportion of all nutritional contents in nutritional agents. METHODS:Sixty-eight tube feeding patients with hyperglycemia after craniocerebral injury at recovery phase,who were in accordance with the main diagnostic points for all cerebrovascular diseases in the Fourth National Academic Meeting about Cerebrovascular Disease,were selected from the Departments of Neurology and Neurosurgery of China Medical University.All the patients were identified to be with the blood glucose of 6.7-17.5 mmol/L with cranial CT or MRI, and all of them had no history of dystrophia or dysphagia.They were randomly divided into control group(receiving standard formula Ensure)and study group(receiving a special formula glucerna),and nasogastric tube feeding was used in both groups,so as to observe the changes in consciousness,ADL,swallow function, nutrition-associated indexes and blood glucose before and after treatment. RESULTS:After 3-week nutritional support,the disturbances of consciousness and swallow function were observed obviously in fewer patients of the study group than the control group(P< 0.05).In the study group, the scores of ADL were obviously improved(P< 0.05 or 0.01),the total score of ADL was 63.2±19.8, and level of blood glucose [(8.2±2.4) mmol/L] was improved significantly as compared with that before treatment[(10.0±2.4) mmol/L] and that in the control group.In the control group, the level of blood glucose increased slightly with no significant changes as compared with that before treatment(P >0.05),and the total ADL score was 48.5±18.2, obviously lower than that in the study group (P< 0.05),but there were no obvious changes in the arm circumference and skin fold thickness of brachial triceps(P >0.05).CONCLUSION:The diets with high fat,low carbohydrate and high dietary fiber can effectively reduce the levels of blood glucose and improve the nutritional status of the patients with hyperglycemia after craniocerebral injury.