重症高血压脑出血术后不同时期不同鼻饲途径肠内营养干预的疗效比较

Effects of different nasal feeding methods on enteral nutrition in patients with severe hypertensive intracerebral hemorrhage at different stages after operation

目的:研究重症高血压脑出血(HICH)术后不同时期、不同鼻饲途径肠内营养(EEN)干预的疗效及对神经功能、肠黏膜屏障功能的影响。方法:选取华中科技大学同济医学院附属武汉中心医院2017年3月至2018年2月收治的HICH重症患者98例,按就诊手术治疗时间顺序排号,进行肯德尔系数盲法分组,鼻空肠组(n=49),针对HICH状态选择在不同时机[T1时段16例(术后0~24 h),T2时段16例(术后25~48 h),T3时段17例(术后49~72 h)]开展早期鼻空肠EEN干预;鼻胃管组(n=49),分别在各时段[T1时段16例(术后0~24 h),T2时段16例(术后25~48 h),T3时段17例(术后49~72 h)]给予鼻胃管EEN干预。比较各组Hb、Glu、BUN、Alb,神经功能指标(S100B、MBP、GFAP、NSF)及肠黏膜屏障功能(DAO、D-乳酸),评估术后7、14、28 d HICH患者格拉斯哥昏迷评分量表(GCS)评分改善情况;记录两组并发症。结果:经术后14 d鼻饲EEN干预,两组Alb、S100B、NSF、GFAP、MBP、GCS评分、DAO、D-乳酸均明显改善(P<0.05),差异有统计学意义;鼻空肠组T1、T2、T3不同时段EEN干预患者术后14 d S100B、NSF、GFAP、MBP、GCS评分、DAO、D-乳酸改善幅度明显优于鼻胃管组(P<0.05),且鼻空肠组T2时段EEN干预效果最优。鼻空肠组术后并发症明显少于鼻胃管组(P<0.05),且鼻空肠组T2时段实施EEN干预者并发症发生率最低。结论:重症HICH术后25~48 h内建立鼻空肠鼻饲途径实施EEN干预可促进患者机体肠道功能、代谢功能恢复,减少并发症,改善神经功能,安全性较高。

Objective:To investigate the effect of enteral nutrition,nerve function and intestinal mucosal barrier function in patients with severe hypertensive intracerebral hemorrhage(HICH).Methods:From March 2017 to February 2018,98 patients with severe HICH were divided into two groups by Kendall coefficient blind method.In the naso-jejunum group(n=49),early naso-jejunal nutrition was carried out at different time of HICH in 16 cases(24 hours after operation),16 cases(25-48 h after operation)and 17 cases(49-72 h after operation).In the nasogastric tube group(n=49),16 cases(24 hours after operation),16 cases(25-48 h)at T2 stage(postoperative 49-72 h)and 17 cases(49-72 h after operation)were given nasogastric tube enteral nutrition respectively.The Hb,Glu,BUN,Alb,neurological function index(S100B)and intestinal mucosal barrier function(DAO,Dlactic acid)were compared in each group to evaluate the improvement of GCS score in patients with HICH at day 14 and day 28 after operation,and the complications of both groups were recorded.Results:After 14 days of nasal feeding EEN,the Alb,S100B,NSF,GFAP,MBP,GCS score and DAO,D-lactic acid in the naso-jejunum group and the nasogastric tube group were significantly improved(P<0.05).In the naso-jejunum group,the DAO,Dlactic acid was significantly improved in the patients with EEN at 14 days after operation(P<0.05),and the EEN intervention in the naso-jejunum group at T2 stage was the best(P<0.05),and the improvement of DAO,D-lactic acid was better than that in the nasogastric tube group(P<0.05).Postoperative complications in the naso-jejunal group were significantly lower than those in the nasogastric tube group(P<0.05),and the incidence of complications in the naso-jejunum group was the lowest when EEN was used in T2 period.Conclusion:The establishment of naso-jejunal feeding via naso-jejunal feeding in 25-48 h after severe HICH can promote the recovery of intestinal function,metabolic function,reduce complications and improve nerve function.