鼻肠管在脑卒中误吸高风险患者中的应用效果

Application effect of nasointestinal tube in patients with high risk of stroke aspiration by mistake

目的探讨鼻肠管在脑卒中误吸高风险患者中的应用效果。方法选取2017年3~12月该院神经内科一区住院的脑卒中误吸高风险患者61例,应用随机数字表法分为对照组40例和观察组21例。对照组采用鼻胃管行肠内营养支持,观察组采用鼻肠管行肠内营养支持。比较两组的肠内营养并发症发生率、营养状况指标、免疫功能指标、格拉斯哥昏迷指数(GCS)评分、神经功能缺损(NIHSS)评分、机械通气时间、ICU治疗时间、30 d病死率。结果观察组的肠内营养并发症总发生率低于对照组(P<0.05)。治疗后,两组的血红蛋白、白蛋白、转铁蛋白等营养状况指标均较治疗前显著增高(P<0.05),而观察组的各项营养状况指标均高于对照组(P<0.05)。治疗后,两组的CD3+、CD4/CD8等免疫功能指标均较治疗前显著增高(P<0.05),而观察组的各项免疫功能指标均高于对照组(P<0.05)。治疗后,两组的GCS评分均较治疗前增高(P<0.05),而观察组的GCS评分高于对照组(P<0.05)。治疗后,两组的NIHSS评分均较治疗前降低(P<0.05),而观察组的NIHSS评分低于对照组(P<0.05)。观察组的机械通气时间、ICU治疗时间均显著短于对照组(P<0.05)。两组的30 d病死率比较,差异无统计学意义(P>0.05)。结论在脑卒中误吸高风险患者中应用鼻肠管行肠内营养治疗,可有效减少患者误吸、反流等并发症的发生,有利于改善患者营养状况、免疫功能、意识状态及神经功能,缩短其治疗时间,使其病死率降低,改善预后。

Objective To investigate the effect of nasointestinal tube in patients with high risk of stroke aspiration.Methods A total of 61 patients with high risk of stroke aspiration by mistake who were hospitalized in the department of neurology in the first district of the hospital from March to December 2017 were selected and divided into the control group(40 cases)and the observation group(21 cases)by random number table method.The control group received enteral nutrition support by nasogastric tube,and the observation group received enteral nutrition support by nasointestinal tube.The incidence of enteral nutritional complications,nutritional status indicators,immune function indicators,Glasgow coma index(GCS)score,neurological deficit(NIHSS)score,mechanical ventilation time,ICU treatment time,and mortality at 30 days were compared between the two groups.Results The total incidence of enteral nutrition complications in the observation group was lower than that in the control group(P<0.05).After treatment,the nutritional status indexes of hemoglobin,albumin and transferrin in both groups were significantly higher than before treatment(P<0.05),while the nutritional status indexes of the observation group were higher than those of the control group(P<0.05).After treatment,CD3+,CD4/CD8 and other immune function indicators in both groups were significantly higher than those before treatment(P<0.05),while the immune function indexes in observation group were higher than that of control group(P<0.05).After treatment,GCS scores in both groups were higher than before treatment(P<0.05),while the GCS score in the observation group was higher than that in the control group(P<0.05).After treatment,NIHSS scores of both groups were lower than before treatment(P<0.05),while the NIHSS score in the observation group was lower than that in the control group(P<0.05).Mechanical ventilation time and ICU treatment time in the observation group were significantly shorter than those in the control group(P<0.05).There was no statistically significant difference in the case fatality rate between the two groups on 30 days(P<0.05).Conclusions The application of nasointestinal nutrition therapy in patients with high risk of stroke aspiration by accident can effectively reduce the occurrence of complications such as aspiration by accident and reflux,which is conducive to improving the nutritional status,immune function,consciousness state and neurological function of patients,shortening the treatment time,reducing the mortality and improving the prognosis.