内镜下鼻空肠置管肠内营养对急性期重症脑卒中患者的临床价值

Clinical Value of Enteral Nutrition by Nasojejunal Feeding Tube Under Endoscope in the Treatment of Severe Stroke Patients in Acute Stage

目的探讨内镜下鼻空肠置管肠内营养对急性期重症脑卒中患者的临床价值。方法纳入2013年至2014年我院神经内科ICU急性期重症脑卒中住院患者53例,将其随机分为试验组(n=27)和对照组(n=26)。试验组患者行内镜下鼻空肠置管肠内营养,对照组行肠外营养。比较两组患者入院前及出院时的体重,比较两组患者入院第第1d、14d、21d血清白蛋白(Alb)、红蛋白(Hb)及甘油三酯(TG)水平,对比观察两组患者肺部感染发生率、感染持续时间、气管插管率和入住ICU时间。结果出院时,试验组体重为(57.3±13.5)kg,对照组体重为(52.7±12.3)kg,两组患者体重比较差异有统计学意义(P<0.05)。入院第21d比较,两组TP、ALB、Hb比较差异有统计学意义(P<0.05)。入院第21d,试验组NIHSS评分为(10.3±3.9),对照组NIHSS评分为(13.8±6.6),差异有统计学意义(P<0.05)。试验组患者肺部感染的发生率较对照组明显降低,感染持续时间缩短,气管插管比例下降,入住ICU时间缩短,两组比较差异有统计学意义(P<0.01)。结论内镜下鼻空肠置管肠内营养操作过程简便,成功率高,适合临床工作,能够改善脑卒中患者的营养状态,促进康复,改善预后。

Objective To investigate the clinical value of enteral nutrition by nasojejunal feeding tube under endoscope in the treatment of severe stroke patients in acute stage. Methods We adopted 53 cases of hospitalized severe stroke patients in acute stage received by ICU,department of neurology in our hospital between 2013 and 2014,who were randomly divided into experimental group（ n = 27） and control group（ n = 26）. Experimental group underwent endoscopic nasojejunal tube to receive enteral nutrition,and the control group received parenteral nutrition. We compared the weight of the two-group patients when admitted into hospital and leaving hospital,we compared the serum albumin（ Alb）,hemoglobin（ Hb）,triglyceride（ TG） levels of the two groups of patients,1d,14 d,21d after admission,and we also contrastly observed incidence of pulmonary infection,duration of infection,the rate of endotracheal intubation and duration of ICU staying. Results When leaving hospital,body weight of patients in experimental group averaged（ 57. 3±13. 5 kg）,and body weight of patients in control group averaged（ 52. 7±12. 3 kg）,the difference of body weight between the two groups having statistical significance（ P〈0. 05）. 21 d after admission,the difference of TG,Alb and Hb testing scores between two groups showed statistical significance（ P〈0. 05）. 21 d after admission,NIHSS scores of experimental group averaged（ 10. 3±3. 9）,while NIHSS scores of control group averaged（ 13. 8±6. 6）,the difference being statistically significant（ P〈0. 05）. The incidence of pulmonary infection in the experimental group was significantly lower than that of the control group,the duration of infection was shortened,the proportion of tracheal intubation decreased and the ICU staying time was shortened,the difference between the two groups being statistically significant（ P〈0. 01）. Conclusion Management of endoscopic nasojejunal feeding tube is simple and convenient,with a high success rate,suitable for clinical work. It can improve the nutritional status of patients with stroke,promote rehabilitation and improve prognosis.