重症脑卒中患者早期肠内与肠外营养支持的效果比较

Comparison of the clinical effects of early enteral and parenteral nutrition support in patients with severe stroke

目的比较早期肠内与肠外营养支持用于重症脑卒中患者的临床效果。方法选择永康市第一人民医院2017年6月至2018年7月收治的重症脑卒中患者65例为研究对象,采用随机数字表法分为对照组32例和观察组33例,对照组采取早期肠外营养支持,观察组实施早期肠内营养支持。比较两组的营养指标、生化指标、美国国立卫生研究院卒中评分量表(NIHSS)评分、临床肺部感染(CPIS)评分及并发症发生情况。结果营养支持后,观察组血清总蛋白(TP)、白蛋白(Alb)、血红蛋白(Hb)分别为(57.01±2.59)g/L、(39.98±2.64)g/L、(126.86±10.75)g/L,均高于对照组的(54.28±0.76)g/L、(37.31±2.35)g/L、(120.75±13.46)g/L,差异均有统计学意义(t=5.727、4.302、2.025,均P<0.05);观察组血糖(GLU)、血肌酐(SCr)、丙氨酸氨基转移酶(ALT)分别为(12.35±2.38)mmol/L、(84.37±13.62)μmol/L、(47.84±4.03)U/L,均低于对照组的(14.18±2.37)mmol/L、(91.84±13.21)μmol/L、(66.28±3.76)U/L(t=3.106、2.244、19.060,均P<0.05);观察组甘油三酯(TG)、血尿素氮(BUN)分别为(1.95±0.45)mmol/L、BUN(5.80±0.61)mmol/L,均高于对照组的(1.66±0.30)mmol/L、(5.32±0.43)mmol/L(t=0.341、3.656,均P<0.05);观察组NIHSS评分(10.31±2.10)分、CPIS评分(3.00±0.76)分,均低于对照组的(14.68±2.75)分、(3.79±1.45)分(t=5.279、2.763,P=0.001、0.008);观察组并发症发生率(9.38%,3/33)低于对照组(31.25%,10/32),差异有统计学意义(χ^2=4.986,P<0.05)。结论早期肠内营养支持与早期肠外营养支持相比,更能够改善重症脑卒中患者的营养状况,安全有效。

Objective To compare the clinical effects of early enteral and parenteral nutrition support in patients with severe stroke.Methods From June 2017 to July 2018,65 patients with severe stroke admitted in the First People's Hospital of Yongkang were selected in the study,and the patients were randomly divided into control group(32 cases)and observation group(33 cases)according to the digital table.The control group received early parenteral nutrition support,while the observation group received early enteral nutrition support.The nutritional index,biochemical index,NIHSS score,CPIS score of clinical pulmonary infection and the incidence of complications were compared between the two groups.Results After nutritional support,the serum levels of total protein(TP),albumin(Alb),hemoglobin(Hb)in the observation group were(57.01±2.59)g/L,(39.98±2.64)g/L,(126.86±10.75)g/L,respectively,which were significantly higher than those in the control group[(54.28±0.76)g/L,(37.31±2.35)g/L,(120.75±13.46)g/L](t=5.727,4.302,2.025,all P<0.05).The serum levels of glucose(GLU),creatinine(SCr),alanine aminotransferase(ALT)in the observation group were(12.35±2.38)mmol/L,(84.37±13.62)μmol/L,(47.84±4.03)U/L,respectively,which were lower than those in the control group[(14.18±2.37)mmol/L,(91.84±13.21)μmol/L,(66.28±3.76)U/L](t=3.106,2.244,19.060,all P<0.05).The levels of triglyceride(TG),serum urea nitrogen(BUN)in the observation group were(1.95±0.45)mmol/L,(5.80±0.61)mmol/L,respectively,which were higher than those in the control group[(1.66±0.30)mmol/L,(5.32±0.43)mmol/L](t=0.341,3.656,all P<0.05).The scores of NIHSS and CPIS in the observation group were(10.31±2.10)points and(3.00±0.76)points,respectively,which were lower than those in the control group[(14.68±2.75)points,(3.79±1.45)points](t=5.279,2.763,P=0.001,0.008).The incidence of complications in the observation group[9.38%(3/33)]was lower than that in the control group[31.25%(10/32)],and the difference was statistically significant(χ^2=4.986,P<0.05).Conclusion Compared with early parenteral nutrition support,early enteral nutrition support can improve the nutritional status of patients with severe stroke and is safe and effective.