胃管与鼻空肠管肠内营养在重型颅脑损伤患者中应用的比较

Application of Gastric Tube and Naso-jejunal Tube in Patients with Severe Craniocerebral Injury: A Comparative Study of Enteral Nutrition

目的比较胃管与鼻空肠管2种肠内营养途径在重型颅脑损伤患者中的应用效果。方法将60例重型颅脑损伤患者按照住院号分成两组进行肠内营养,一组采用胃管,另一组采用鼻空肠管。记录两组置管前及置管后第2、第5、第10天的营养情况,包括血清总蛋白、前白蛋白、血红蛋白含量;记录两组置管10 d内并发症发生率,包括腹泻、消化道出血、反流、误吸及吸入性肺炎;用格拉斯哥预后评分表评定两组患者的预后情况;比较两组患者入住监护病房的时间,分析经济与效益的关系。结果置管后第5天鼻空肠管组的总蛋白、前白蛋白、血红蛋白的含量均高于胃管组,第10天鼻空肠管组的总蛋白、前白蛋白的含量均高于胃管组;鼻空肠管组反流率低于胃管组;两组的格拉斯哥预后评分显示鼻空肠管组预后优于胃管组;鼻空肠管组比胃管组入住监护室的时间短:以上差异均有统计学意义(P<0.05)。结论在重型颅脑损伤患者中使用鼻空肠管给予肠内营养更能改善其营养状况,减少并发症,更有利于患者康复。

Objective To compare the effects of two enteral nutrition pathways, gastric tube and naso-jejunal tube, on patients with severe craniocerebral injury. Methods Based on admission number, 60 patients were divided into two groups to receive nutrition through gastric tube and naso-jejunal tube respectively. Two groups＇ nutrition conditions, including serum total protein, prealbumin and hemoglobin content were recorded before and the 2nd, 5th, and 10th day after the intubation. Comparisons of complications were done within 10 days after intubation, including diarrhea, gastrointestinal bleeding, regurgitation, aspiration, and aspiration pneumonia, as well as duration in cure unit. Prognoses of the two groups were assessed by Glasgow Outcome Scale. Results Content of serum total protein, prealbumin on 5th and lOth days after intubation and hemoglobin in 5th day were higher in group with naso-jejunal tube than in group with gastric tube. Group with naso-jejunal group was low in regurgitation, superior in prognosis, short in duration of care unit and high in economic benefit. All the differences were statistically significant （P〈0.05）. Conclusion Enteral nutrition through naso-jejunal tube is effective for patients with severe craniocerebral injury in improving nutrition, reducing complications, and recovery.