鼻肠管在重症颅脑损伤机械通气患者肠内营养中的应用

Application of enteral nutrition through nasointestinal tube in severe craniocerebral trauma patients with mechanical ventilation

目的 探讨在重症颅脑损伤机械通气患者中留置鼻肠管行肠内营养的应用效果.方法 将ICU收治的58例重症颅脑损伤机械通气患者随机分为观察组和对照组.观察组留置鼻肠管进行肠内营养,对照组采用传统鼻饲方法行肠内营养.对两组患者可以耐受肠内营养的起始时间、达到目标喂养量所需时间、并发症及呼吸机相关性肺炎（VAP）发生情况、机械通气时间、治疗费用、住院时间等进行比较.结果 鼻肠管组患者耐受肠内营养的起始时间为（18.23±10.16）h、达到目标喂养量所需时间为（74.78±28.42）h,传统鼻饲组分别为（35.44±13.55）,（171.67±32.13）h,差异均有统计学意义（t值分别为5.4723,12.2013;P ＜0.01）.鼻肠管组机械通气时间为（6.05±3.17）d、住院时间为（32.22±10.13）d、人均住院费用为（8.17±3.23）万元,传统鼻饲组分别为（10.43±4.98）d,（45.44±12.17）d,（12.45±5.67）万元,差异均有统计学意义（t值分别为3.995 5,4.4960,3.532 1;P ＜0.05）.鼻肠管组胃肠道并发症及呼吸机相关性肺炎发生率低于传统鼻饲组,差异有统计学意义（x2 =20.01,P＜0.01）.结论 对重症颅脑损伤机械通气患者留置鼻肠管行肠内营养效果优于传统鼻饲方法.

Objective To evaluate the effect of enteral nutrition through nasointestinal tube （NIT） applying in severe craniocerebral trauma patients with mechanical ventilation. Methods A total of 58 severe craniocerebral trauma patients with mechanical ventilation in ICU were randomly divided into two groups： observation group with NIT enteral nutrition and control group with the traditional nasal feeding. The starting time to tolerate enteral nutrition, the time it took to reach the target feeding, the occurrence of complications and ventilator-associated pneumonia （ VAP）, the duration of mechanical ventilation, the cost of treatment, the length of hospital stay were compared between the two groups. Results The starting time to tolerate enteral nutrition was （ 18. 23 ± 10. 16） h in the observation group and （35.44 ± 13.55） h in the control group; the time it took to reach the target feeding was （74.78 ±28.42） h in the observation group and （ 171.67 ± 32. 13） h in the control group, respectively; and the differences were statistically significant （ t = 5.472 3,12. 201 3 ; P 〈 0.01）. In the observation group, the duration of mechanical ventilation was （6.05 ± 3. 17 ） d, the length of hospital stay was （32. 22 ± 10. 13）d and the per capita hospital costs was （8. 17 ± 3.23 ） ten thousand yuan, and then those in the control group were （ 10.43 ± 4. 98 ） d, （45.44 ± 12. 17） d, （ 12. 45 ± 5.67） ten thousand yuan, respectively, and the differences were statistically significant （t = 3. 995 5,4. 496 0,3. 532 1 ;P 〈 0. 05 ）. The incidence of gastrointestinal complications and ventilator-associated pneumonia （VAP） in the observation group was less than that in the control group, and the difference was statistically significant （ X2 = 20. 01, P 〈 0. 01 ）. Conclusions The effect of NIT enteral nutrition is better than that of the traditional nasal feeding method applying in severe craniocerebral trauma patients with mechanical ventilation.