鼻空肠管营养加鼻胃管减压在重症高血压脑出血并胃瘫中的应用研究

Application research of nasojejunal feeding and nasogastric tube decompression in severe hypertensive intracerebral hemorrhage complicated with gastroparesis

目的探讨鼻空肠管营养加鼻胃管减压在重症高血压脑出血并胃瘫患者中的应用效果。方法将2011年1月至2014年6月入院的56例重症高血压脑出血并胃瘫患者作为研究组，将2007年1月至2010年12月入院的同类患者52例作为对照组。研究组患者于确诊并发胃瘫后采用鼻空肠管营养加鼻胃管减压方式；对照组常规先采用鼻胃管营养方式，15d后仍不能耐受肠内营养者改为肠外营养治疗。观察两组患者体质量、血清白蛋白、前白蛋白及血红蛋白等营养指标以及并发症的发生情况。病后3个月时按日常生活能力（ADL）分级法评定预后，将Ⅰ～Ⅲ级归为预后良好，Ⅳ、Ⅴ级及死亡归为预后不良。结果治疗前两组体质量差异无统计学意义，4周后研究组与对照组平均体质量比较差异有统计学意义[（57．2±5．3）kg与（52．8±4．9）kg；t=4．33，P〈0．01）]；入院后3、4周研究组的血清白蛋白分别为（34．5±3．3）、（37．8±3．8）g／L，前白蛋白为（202．3±16．7）、（216．9±17．1）g／L，血红蛋白为（119．4±12．1）、（126．2±12．8）g／L，对照组血清白蛋白分别为（30．7±3．1）、（34．1±3．4）g／L，前白蛋白为（179．6±15．2）、（203．1±15．4）g／L，血红蛋白为（107．7±11．3）、（113．5±11．9）g／L，研究组营养状态明显优于对照组（t值分别为6．16、5．32、7．37、4．85、5．18、5．32，P均〈0．01）；而并发症明显少于对照组（P均〈0．05）；3个月后研究组预后良好率为80．36％（45／56），对照组为61．54％（32／52），差异有统计学意义（χ2=4．67，P〈0．05）。结论对于重症高血压脑出血并胃瘫患者采用鼻空肠管营养加鼻胃管减压方式，可有效改善患者的营养状态，增强机体抵抗力，降低并发症发生率，明显改善预后。

Objective To investigate the effects of nasojejunal feeding plus nasogastric tube decompression in severe hypertensive intracerebral hemorrhage complicated with gastroparesis. Methods Fifty- six cases of severe hypertensive intracerebral hemorrhage complicated with gastroparesis admitted to hospital from January 2011 to June 2014 were chosen as study group,while the 52 cases of similar patients admitted to hospital from January 2007 to December 2010 were chosen as control group. Nasojejunal feeding and nasogastric tube decompression were given to the study group. Nasogastric enteral nutrition ＇support therapy was firstly given to the control group conventionally, after 15 days if they still could to be tolerant of the enteral nutrition, then parenteral nutrition therapy were adopted. The weight, serum albumin, prealbumin and hemoglobin circumstances of the two groups were determined and the complications were recorded. The patients were followed up according to activity of daily living（ADL） after 3 months. Results There was no significant difference on the average body weigh between two groups before treatment. The average body weight of the study group was significantly higher than that of the control group after 4 weeks treatment（（57. 2±5.3） kg vs. （52. 8±4.9） kg,t=4. 33,P〈0. 01 ）. The serum albumin,pre albumin and hemoglobin of 3 week, four week after treatment were significantly higher than those of the control group（ serum albumin of 3 week： （ 34. 5±3.3 ） g/L vs. （ 30. 7±3.1 ） g/L; erum albumin of four week： （37.8±3.8） g/L vs. （34. 1±3.4） g/L;serum prealbumin of 3 week： （202. 3±16. 7） g/L vs. （ 179. 6 ± 15.2） g/L;sei＇um prealbumin of four week： （ 216.9 ±17.1 ） g/L vs. （203.1 ± 15.4） g/L; hemoglobin of 3 week ： （ 119.4± 12. 1 ） g/L vs. （ 107.7 ±11.3） g/L; hemoglobin of four week ： （ 126. 2± 12. 8） g/L vs. （ 113.5 ±11.9） g/L）. Nutritional status of study group was significantly better than that of the control group （t = 6. 16, 5.32,7. 37,4. 85,5.18,5.32;P〈0. 01 ）,and complications was significantly less than that of the control group （P〈0. 05）. After three months, the good prognosis rate of study group （ 80. 36% （45/56） ） was significantlyhigher than that of the control group （ 61.54% （32/52） ）, the difference was statistically significant （ χ2 = 4. 67, P 〈0. 05 ）. Conclusion Nasojejunal feeding plus nasogastric tube decompression for patients with severe hypertensive intraeerebral hemorrhage with gastroparesis can improve nutritional status, enhance their body resistance, reduce the incidence of complications, and improve their prognosis.