鼻空肠与鼻胃管管饲的急性重症卒中患者的肺炎

Pneumonia in severe acute stroke patients fed by nasojejunal versus nasogastric tube

目的探讨鼻空肠管与鼻胃管肠内营养支持对重症急性卒中患者卒中相关性肺炎（stroke associated pneumonia，SAP）以及其他并发症的影响。方法共纳入60例需要管饲的重症急性卒中患者，随机分为鼻空肠管组和鼻胃管组进行肠内营养支持，观察2周内SAP、腹泻、呕吐、消化道出血和低钠血症的发生，记录置管前以及置管后7d和14d时的营养指标（总蛋白、前白蛋白、血红蛋白）并进行比较。结果鼻空肠管组和鼻胃管组各30例，2组人口统计学和基线临床资料均无显著差异。鼻空肠管组SAP（43．3％对70．0％；X2=4．340，P=0．037）、呕吐（13．3％对43．3％；X2=6．648，P=0．010）和低钠血症（16．7％对40．0％；X2=4．022，P=0．045）发生率显著低于鼻胃管组，但腹泻和消化道出血发生率无显著差异。鼻空肠管组置管后14d时的血浆总蛋白和前白蛋白浓度与置管前无显著差异，但血红蛋白浓度显著降低（P=0．001）；相比之下，鼻胃管组置管后14d时血浆总蛋白（P=0．001）、前白蛋白（P=0．036）和血红蛋白（P=0．001）浓度与置管前相比均显著降低。结论重症急性卒中患者鼻空肠肠内营养能有效预防SAP以及呕吐和低钠血症的发生，并且有助于维持患者的营养状况。

Objective To investigate the effects of enteral nutrition via the nasojejunal and nasogastric feeding on stroke-associated pneumonia （SAP） and other complications in patients with severe acute stroke. Methods A total of 60 patients with severe acute stroke who needed tube feeding were randomized to either a nasojejunal tube group or a nasaogastric tube group for enteral nutrition support. The occurrence of SAP, diarrhea, vomiting, and gastrointestinal bleeding within 2 weeks were observed. The nutrition indices （total protein, prealbumin, and hemoglobin） before and at day 7 and 14 after the tube placement were documented and compared.Results There were 30 patients in the nasojejunal tube group and the nasaogastric tube group, respectively. There were no significant difference in demographic and baseline clinical data between the 2 groups. The incidence of SAP （43.3% vs. 70. 0% ;X2 =4. 340, P =0. 037）, vomiting （13.3% vs. 43.3% ; X2 = 6. 648, P = 0. 010）, and hyponatremia （6. 7% vs. 40. 0~7o ; X2 = 4. 022, P = 0. 045） in the nasojejunal tube group were significant lower than those in the nasogastric tube group, however, there was no significant differences in the incidences of diarrhea and gastrointestinal bleeding. Compared with before indwelling tube, there were no significant difference in the concentrations of total plasma protein and prealbumin at day 14 after indwelling tube in the nasojejunal tube group, but the concentration of hemoglobin were decreased significantly （P = 0. 001）; compared with before indwelling tube, the concentrations of the total plasma protein （P = 0. 001 ）, prealbumin （P = 0. 036）, and hemoglobin （P = 0. 001 ） at day 14 after indwelling tube in the nasogastric tube group were significantly decreased. Conclusions Nasojejunal nutrition may effectively prevent SAP, volmiting, and hyponatremia in patients with severe acute stroke, and contributes to maintain the nutritional status.