早期肠内营养联合补充性肠外营养在老年急性缺血性脑卒中机械取栓术患者中的应用

Application of early enteral nutrition combined with supplementary parenteral nutrition in acute ischemic stroke elderly patients with mechanical embolectomy

目的探讨早期肠内营养（EEN）加补充性肠外营养（SPN）在老年急性缺血性脑卒中机械取栓术后治疗中的作用。方法回顾性收集2015年10月-2017年6月老年急性缺血性脑卒中机械取栓治疗接受营养支持患者35例，根据是否接受SPN，分为单纯EEN组9例，EEN＋SPN组26例。分析两组患者的临床资料和疗效，总结术前、术后1周及术后2周的血红蛋白（HGB）、总蛋白（TP）、总淋巴细胞计数（TLC）、血清白蛋白（ALB）等营养监测指标，比较肺部感染、腹泻、消化道出血等并发症的发生率，比较两组患者的平均住院日、住院费用和疾病结局。结果EEN＋SPN组24例治愈出院，2例死亡；EEN组9tJtJ均治愈出院。两组手术前后HGB、TP、TLC、ALB差异无统计学意义（P〉0．05）；EEN组术前与术后2周ALB差异有统计学意义（P〈0．05）。EEN＋SPN组肺部感染、腹泻、消化道出血的发生率分别为65．38％、19．23％、11．54％，与EEN组比较差异无统计学意义（P〉0．05）。EEN＋SPN组平均住院日（22．94±12．91）d，住院费用（12．53±4．98）万元，与EEN组比较差异无统计学意义（P〉0．05）。结论老年急性缺血性脑卒中机械取栓术后的患者给予单纯EEN容易导致ALB下降，应结合病情，给予EEN联合SPN，防止低蛋白血症，改善营养状态。

Objective To explore the effects of early enteral nutrition （EEN） combined with supplementary parenteral nutrition （SPN） in acute ischemic stroke elderly patients after mechanical embolectomy. Methods From October 2015 to June 2017, we retrospectively collected 35 acute ischemic stroke elderly patients treated with nutritional support after mechanical embolectomy. All of the patients were divided into alone EEN group （n=9） and EEN＋SPN group （n=26） according to whether to accept SPN or not. We analyzed the clinical data and curative effects, and summarized nutritional monitoring indexes such as the hemoglobin （HGB）, total protein （TP）, total lymphocyte count （TLC）, serum albumin （ALB） before and one, two weeks after surgery and compared the incidence of complications such as pulmonary infection, diarrhea, gastrointestinal hemorrhage as well as average hospital day, hospitalization expenses, outcome of disease. Results There were 24 patients who were cured and discharged from hospital and two patients who were fatal in EEN＋SPN group. There were 9 patients who were cured and discharged from hospital. There was no significant difference in HGB, TP, TLC, ALB between two groups before and after surgery （P 〉 0.05）. The difference in ALB of EEN group two weeks after surgery was significant which was compared with that before surgery （P 〈 0.05）. The incidence of pulmonary infection, diarrhea, gastrointestinal hemorrhage of EEN＋SPN group was 65.38%, 19.23%, 11.54% respectively with no significant difference with those of EEN group （P 〉 0.05）. There was no significant difference in average hospital day and hospitalization expenses between EEN＋SPN group [ （22.94 ± 12.91）d, （12.53 ± 4.98） ten thousand yuan, respectively ] and EEN group （P 〉 0.05）. Conclusions The application of alone EEN in acute ischemic stroke elderly patients after mechanical embolectomy may easily cause that the level of ALB decreases. The EEN＋SPN may be applied according to patient＇s condition so as to prevent hypoproteinemia and improve the nutritional state.