脑卒中早期肠内营养对于患者营养健康和预后的影响

Influence by stroke early enteral nutrition on nutrition health and prognosis in patients

目的探讨对脑卒中患者施以早期肠内营养方案对其营养健康水平与预后的影响。方法 134例脑卒中患者依照不同营养支持方式分为常规营养组与肠内营养组,各67例。基于基础护理,常规营养组采取常规鼻饲流质饮食的方法 ,肠内营养组基于常规营养组的治疗方案采取早期免疫肠内营养,在入院1、14 d后,比较两组营养指标水平[血清白蛋白(ALB)、血红蛋白(HGB)、血清总蛋白(TP)、转甲状腺素蛋白(TTR)]、格拉斯哥昏迷评分法(GCS)评分。结果经营养指标检测,入院1 d后,肠内营养组ALB(38.71±4.97)g/L、HGB(134.79±12.48)g/L、TP(68.64±5.13)g/L、TTR(254.16±23.15)mg/L;常规营养组ALB(38.82±4.25)g/L、HGB(134.52±11.85)g/L、TP(68.26±5.21)g/L、TTR(254.42±22.95)mg/L;入院1 d后两组各项营养指标比较差异无统计学意义(P>0.05)。入院14 d后,肠内营养组ALB(36.84±3.15)g/L、HGB(129.12±11.05)g/L、TP(66.74±4.59)g/L、TTR(289.74±23.84)mg/L;常规营养组ALB(32.74±2.41)g/L、HGB(113.74±10.42)g/L、TP(61.41±4.15)g/L、TTR(236.46±22.76)mg/L;肠内营养组入院14 d后各项营养指标与入院1 d后比较差异无统计学意义(P>0.05),常规营养组各项营养指标水平则显著低于入院1 d后和同时间的肠内营养组(P<0.05)。入院1 d后,肠内营养组GCS中评分言语反馈(2.31±0.17)分,睁眼功能(2.71±0.18)分,肢体动作(3.16±0.14)分,总分(8.18±1.56)分;常规营养组中言语反馈(2.32±0.25)分,睁眼功能(2.59±0.19)分,肢体动作(3.12±0.15)分,总分(8.03±1.47)分;入院1 d后两组GCS各项评分及总分比较差异无统计学意义(P>0.05)。入院14 d后,肠内营养组GCS中评分言语反馈(3.98±0.15)分,睁眼功能(3.57±0.24)分,肢体动作(4.04±0.27)分,总分(11.59±2.13)分;常规营养组中言语反馈(2.24±0.11)分,睁眼功能(2.94±0.21)分,肢体动作(3.37±0.23)分,总分(8.55±2.06)分;肠内营养组入院14 d后GCS各项评分及总分较入院1 d后显著上升,且显著高于同时间常规营养组的评分,差异具有统计学意义(P<0.05)。结论早期肠内营养支持可维持脑卒中所需的营养水平,对患者预后意识及感官恢复有所帮助,是针对脑卒中患者可行性高的营养方案。

Objective To investigate influence by early enteral nutrition on nutrition health leveland prognosis in stroke patients.Methods A total of134stroke patients were divided by different nutritionsupport measures into conventional nutrition group and enteral nutrition group,with67cases in each group.Onthe basis of basic nursing,the conventional nutrition group received conventional nasal feeding liquid diet,and the enteral nutrition group received early immune enteral nutrition in addition to treatment for the conventionalnutrition group.Comparison was made on nutrition indexes[serum albumin(ALB),hemoglobin(HGB),serumtotal protein(TP)and transthyretin(TTR)]and Glasgow coma scale(GCS)scores between the two groups in1and14d after admission.Results Detection of nutrition indexes showed that the enteral nutrition group had ALB as(38.71±4.97)g/L,HGB as(134.79±12.48)g/L,TP as(68.64±5.13)g/L and TTR as(254.16±23.15)mg/L in1dafter admission.The conventional nutrition group had ALB as(38.82±4.25)g/L,HGB as(134.52±11.85)g/L,TP as(68.26±5.21)g/L and TTR as(254.42±22.95)mg/L in1d after admission.There was no statisticallysignificant difference of nutrition indexes in1d after admission between the two groups(P>0.05).In14d afteradmission,the enteral nutrition group had ALB as(36.84±3.15)g/L,HGB as(129.12±11.05)g/L,TP as(66.74±4.59)g/L and TTR as(289.74±23.84)mg/L.The conventional nutrition group had ALB as(32.74±2.41)g/L,HGB as(113.74±10.42)g/L,TP as(61.41±4.15)g/L and TTR as(236.46±22.76)mg/L in1d after admission.The enteral nutrition group had no statistically significant difference of nutrition indexes between1d and14dafter admission(P>0.05),while the conventional nutrition group had obviously lower nutrition indexes than thosein1d after admission and in the enteral nutrition group(P<0.05).In1d after admission,the enteral nutrition group had GCS verbal feedback score as(2.31±0.17)points,eye opening function score as(2.71±0.18)points,body movement score as(3.16±0.14)points,and total score as(8.18±1.56)points.The conventional nutritiongroup had verbal feedback score as(2.32±0.25)points,eye opening function score as(2.59±0.19)points,body movement score as(3.12±0.15)points,and total score as(8.03±1.47)points.There was no statisticallysignificant difference of GCS scores and total score in1d after admission between the two groups(P>0.05).In14dafter admission,the enteral nutrition group had GCS verbal feedback score as(3.98±0.15)points,eye openingfunction score as(3.57±0.24)points,body movement score as(4.04±0.27)points,and total score as(11.59±2.13)points.The conventional nutrition group had verbal feedback score as(2.24±0.11)points,eye opening functionscore as(2.94±0.21)points,body movement score as(3.37±0.23)points,and total score as(8.55±2.06)points.The enteral nutrition group had obviously higher GCS scores and total score in14d after admission than those in1d after admission,and its scores were also higher than those in the conventional nutrition group at the same timeperiod.Their difference had statistical significance(P<0.05).Conclusion Early enteral nutrition support canmaintain nutrition level in stroke,and it is helpful for prognosis consciousness and sensory recovery.This methodacts as a highly feasible nutrition scheme for stroke patients.