不同肠内营养方式对颅脑损伤伴吞咽困难患者临床疗效的影响

The effects of applying different enteral nutrition in patients with craniocerebral injury and dysphagia

目的:探讨经皮胃镜下胃造瘘术(PEG)与经鼻胃管(NGT)肠内喂养在颅脑损伤伴吞咽困难患者中的临床应用价值。方法:将50例患者随机分为PEG组和NGT组,每组各25例,分析比较治疗前、治疗4周后两组患者体重指数(BMI)、血清清蛋白(ALB)、前清蛋白(PA)、血红蛋白(Hb)水平、非瘫痪侧肱三头肌皮褶厚度(SFT)和吞咽功能康复训练(洼田评分)的改善情况,同时比较两组患者肺部感染、反流性食管炎、更换营养管、自行拔除胃管、消化道出血、腹膜炎等并发症的发生情况。结果:与NGT组比,治疗4周后PEG组患者的营养状况(BMI、ALB、Hb、SFT)和吞咽功能(洼田评分)改善更加明显比较,差异无统计学意义(P<0.05);肺部感染、反流性食管炎、更换营养管、自行拔除胃管发生率明显减少,差异有统计学意义(P<0.05),而消化道出血、腹膜炎发生率比较,差异无统计学意义(P>0.05)。结论:PEG肠内喂养能更好地改善颅脑损伤伴吞咽困难患者的营养状况,减少肺部感染等相关并发症发生率,是一种安全、有效的治疗方法。

Objective To investigate the efficacy and safety of percutaneous endoscopic gastrostomy（ PEG） and nasogastrictube（ NGT） in patients with craniocerebral injury and dysphagia. Method 50 patients were randomly divided into two groups. 25 in PEG group,and the others in NGT group,Compared and analyzed nutrition and related complications of two groups before and after four weeks treatment,nutrition indexes include body mass index（ BMI）,serum albumin level（ ALB）,serum prealbumin level（ PA）,hemoglobin level（ Hb）,the skinfold thickness（ SFT） of triceps of nonparalytic side and swallowing rehabilitation（ Water swallow test）,and the related complications were pulmonary infection,reflux esophagitis,changing the nutrient tube,self extubation,gastrointestinal hemorrhage,peritonitis complications. Results After four weeks treatment,the PEG group＇ s nutrition improvement（ including BMI,ALB,Hb、SFT） and Swallowing function（ Water swallow test） were better than the NGT group（ P〈0. 05）,ant the incidence of pulmonary infection,reflux esophagitis,changing the nutrient tube,self extubation were lower than the NGT group（ P〈0. 05）,but the incidence of gastrointestinal hemorrhage and peritonitis complications had no obvious differences between the two groups（ P〉0. 05）. Conclusion PEG is a safe and effective treatment for patients with craniocerebral injury and dysphagia,and it is superior to improve patients＇ nutritional status and decrease related complications including pulmonary infection effectively.