神经危重症患者发生胃潴留相关危险因素及营养支持对预后的影响

Risk factors of gastric retention and the impact of nutritional support on prognosis in critical patients with neurology disease

摘要：目的分析神经危重症患者发生胃潴留的相关因素及营养支持对预后的影响。方法选择自2012年7月～2013年2月在吉林大学白求恩第一临床医学院神经内科重症监护室住院患者共73例，根据残留量是否超过200ml，分为胃潴留组和非胃潴留组，胃潴留组给予肠内、肠外联合营养支持，非胃潴留组给予全肠内营养支持。结果神经危重症患者人院时的GCS评分越低，发生胃潴留可能性越大（P〈0．05）；发病1w之内发生胃潴留的人数最多，达68％；营养支持治疗1w、3w时两组间比较血清白蛋白、前白蛋白、转铁蛋白、视黄醇结合蛋白、血红蛋白水平均无明显差异（P〉0．05）；营养支持治疗3w后非胃潴留组患者的IgG、IgA水平高于胃潴留组患者（P〈0．05）。结论神经危重症患者入院时的GCS评分与胃潴留的发生关系最为密切；在发病1w内胃潴留发生率最高；对于有胃潴留的患者行肠内、肠外联合营养可以获得与完全肠内营养支持相似的疗效；完全肠内营养还可改善神经危重症患者的免疫功能。

Objective To investigate the risk factors of gastric retention and the impact of nutritional support on prognosis in critical patients with neurology disease. Methods A total of 73 critically illed patients in Neurology intensive care unit of The First Teaching Hospital of Jilin University from July 2012 to February 2013 were divided into gastric reten- tion group and non gastric retention group according to the residual volume more than 200ml or not. Enteral and parenteral nutrition support is provided to the patients in gastric retention group. Enteral nutrition support is provided to patients in non gastric retention group. Results The lower the GCS of the critically ill patients, the greater chance of gastric retention when admitted to hospital（ P 〈 0.05）. The incidence rate of gastric retention is highest in the first week of the disease at- tack up to 68%. The level of albumin, prealbumin, transferring, retinol binding protein and hemoglobin has no significant difference between two group （ P 〈 0.05 ）. The level of IgG and IgA in non gastric retention group is higher than the gastric retention group after Nutrition three weeks support treatment （ P 〈 0.05 ）. Conclusion GCS score on admission to hospital is significantly associated with the occurrence of gastric retention in neurologic critically illed patients. The incidence rate of gastric retention is highest in the first week of the disease. For the neurologic critically filed patients with gastric retention, enteral and parenteral nutrition support has the same therapeutic effect with enteral nutrition support in patients without gas- tric retention. Enteral nutrition therapy can improve the immune function of critically filed patients with neurologic diseases.