重症脑梗死患者肠内营养误吸的影响因素与护理对策

Influencing factors of misinhalation in patients with severe cerebral infarction undergoing enteral nutrition support and nursing strategies

目的探讨重症脑梗死患者肠内营养误吸的影响因素,总结有效的临床护理措施。方法选择安康市中心医院北院重症医学科于2016年1月至2019年1月期间收治的74例急性脑梗死患者为研究对象,根据是否误吸将患者分为误吸组(n=38)与无误吸组(n=36),比较两组患者的年龄、性别、高血压史、吸烟史、糖尿病史和卒中史、发病部位,以及格拉斯哥昏迷评分(GCS)、美国国立卫生研究院卒中量表评分(NIHSS)等临床资料,分析患者肠内营养误吸的影响因素,总结护理措施。结果误吸组患者的年龄平均为(70.5±12.3)岁,明显高于无误吸组的(66.4±13.5)岁,吸烟史、卒中史、GCS≤12分、NIHSS>10分的比例分别为44.74%、57.89%、78.95%、44.74%,明显高于对照组的25.00%、27.78%、50.00%、19.44%,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,年龄、卒中史、GCS评分、NIHSS评分是重症脑梗死患者误吸的独立危险因素(P<0.05)。结论误吸是重症脑梗死患者肠内营养治疗的常见并发症,其发生与高龄、卒中史,以及昏迷、神经功能缺损程度重有关;临床上应针对上述影响因素采取有效的护理措施,以降低误吸的发生风险。

Objective To explore the influencing factors of misinhalation in patients with severe cerebral infarction undergoing enteral nutrition support,and to summarize effective clinical nursing measures.Methods A total of 74 patients with acute cerebral infarction were selected as the research subjects,who were admitted to the Department of Critical Care Medicine at Ankang Central Hospital(North District)from January 2016 to January 2019.According to whether misinhalation occurred,the patients were divided into misinhalation group(n=38)and non-misinhalation group(n=36).The clinical data were compared between the two groups,including age,gender,history of hypertension,history of smoking,history of diabetes mellitus,history of stroke,location of onset,Glasgow Coma Score(GCS),and the National Institutes of Health Stroke Scale(NIHSS).The influencing factors of misinhalation were analyzed in patients undergoing enteral nutrition support,and the nursing measures were summarized.Results In the misinhalation group,the average age was(70.5±12.3)years,which was significantly higher than(66.4±13.5)years in the non-misinhalation group;and the proportion of smoking history(44.74%vs 25.00%),stroke history(57.89%vs 27.78%),GCS<12(78.95%vs 50.00%)and NIHSS>10(44.74%vs 19.44%)were significantly higher than those in the non-misinhalation group;all differences were statistically significant(P<0.05).Logistic regression analysis showed that age,stroke history,GCS score,and NIHSS score were independent risk factors for misinhalation in patients with severe cerebral infarction.Conclusion Misinhalation is a common complication in patients with severe cerebral infarction undergoing enteral nutrition support,and its occurrence is related to the age,stroke history,and the degree of coma and neurological deficits.Clinically,effective nursing measures should be taken against the above-mentioned influencing factors to reduce the risk of misinhalation.