两种鼻饲途径肠内营养在危重患者中的应用比较

A comparative study of two enteral nutrition routes in the critical patients

目的比较接受肠内营养(EN)治疗的危重症患者对鼻胃管和鼻空肠管的应用效果。方法将入住重症监护病房需要1个月以上EN的60例患者随机分为鼻胃管组和鼻空肠管组,每组30例。记录两组置管前及置管后第2、7、14天的营养情况,包括血清总蛋白、前清蛋白、血红蛋白含量;记录两组置管14d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;同时观察营养液的输注速度与胃肠功能紊乱的发生率。结果置管后第7天鼻空肠管组的总蛋白、前清蛋白、血红蛋白的含量分别为(57.3±3.4)g/L、(228.7±43.5)mg/L、(117.4±24.3)g/L,鼻胃管组分别为(55.2±3.2)g/L、(200.7±22.8)mg/L、(103.5±15.9)g/L,两组比较差异有统计学意义(P<0.05);第14天鼻空肠管组的总蛋白、前清蛋白、血红蛋白的含量分别为(58.3±3.3)g/L、(245.9±42.7)mg/L、(128.5±19.5)g/L,鼻胃管组分别为(55.5±3.4)g/L、(203.5±21.4)mg/L、(123.2±13.6)g/L,两组比较差异也有统计学意义(P<0.05)。鼻空肠管组反流率低于胃管组;患者腹胀、腹泻等胃肠功能紊乱症状与输注营养液的速度明显相关,但两组差异无统计学意义。结论在危重患者中使用鼻空肠管给予EN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 efficacy of nasogastric tube and naso jejunal tube in the critical patients who received enteral nutrition. Methods 60 ICU patients with enteral nutrition above 1 month were randomized into two groups to receive nutrition through gastric tube and naso-jejunal tube respectively. Two groups nutri tions,including serum total protein, prealbumin and hemoglobin content were recorded before and the 2n 14th days after the intubation. Comparisons of complications were done within 14 days after intubation,in arrhea,gastrointestinal bleeding, regurgitation, aspiration, and aspiration pneumonia. The speed of nutrition transfusion and the incidence of gastrointestinal tract disturbance were also observed. Results The content of serum total protein,prealbumin on 7th and 14th days after intubation and hemoglobin in 7th day was higher in the group with naso-jejunal tube than that in the group with gastric tube. The group with naso-jejunal group was low in regurgita tion. There was significant correlation between the incidences of gastrointestinal tract disturbance such as abdominal distention and diarrhea and the speed of nutrition transfusion, but no statistically significant difference was found between the two groups （P〉0.05）. Conclusion Enteral nutrition through naso-jejunal tube is more effective for the critical patients in improving nutrition, reducing complications and recovery.