低温早期肠内营养护理对ICU重症颅脑损伤患者应激性溃疡护理效果研究

Effects of early enteral nutrition nursing at low temperature on stress ulcers in patients with severe head injury in ICU

目的:探讨低温早期肠内营养护理对ICU重症颅脑损伤患者应激性溃疡护理效果。方法:选择2016年2月至2019年1月在我院接受治疗的重症颅脑损伤患者96例进行研究。采用随机数字表法将患者分为2组,每组各48例。观察组肠内营养液温度控制在22℃;对照组肠内营养液温度则在38℃。营养支持7 d后对比两组患者应激性溃疡发生率、胃动力(以间接测量法对患者负压及胃残留量进行检测)、胃液pH(便携式酸度计)、腹泻发生率及营养指标。结果:对照组患者应激性溃疡发生率明显高于观察组(P<0.05),而腹泻发生率与观察组无统计学差异(P>0.05)。两组患者治疗后腹内压、胃残留量及胃液pH水平均明显升高(P<0.05),但对照组升高幅度明显大于观察组(P<0.05)。治疗后两组患者体质量、三头肌皮褶厚度(Triceps skin fold,TSF)及非瘫痪侧上臂三头角肌肌围(Mid-arm muscle circumference,MAMC)均明显下降(P<0.05),但对照组下降幅度更大(P<0.05)。结论:低温早期营养支持较常温早期营养支持可显著降低ICU重症颅脑损伤患者应激性溃疡发生率,改善胃动力,防止胃液pH迅速升高,改善营养指标且不增加腹泻发生率。

Objective:To explore the effect of early low temperature enteral nutrition nursing on stress ulcers in patients with severe head injury in ICU.Methods:A total of 96 patients with severe head injury treated in our hospital from February 2016 to January 2019 were enrolled.Patients were divided into 2 groups using a random number table method,with 48 cases in each group.The temperature of enteral nutrient solution in observation group was controlled at 22℃.The temperature of enteral nutrient solution in control group was 38℃.After 7 days of nutritional support,the incidence of stress ulcers,gastric motility(indirect measurement of patients’negative pressure and gastric residue),gastric juice pH(portable acidity meter),diarrhea incidence and nutrition indicators were compared between the 2 groups.Results:The incidence of stress ulcer in the control group was 14.58%,which was significantly higher than that in the observation group(2.08%,P<0.05).The incidence of diarrhea in the control group was 22.92%,which was not statistically significant compared with 18.75%in the observation group(P>0.05).The intra-abdominal pressure,gastric residual volume and gastric juice pH level of the two groups were significantly increased after treatment,but the increase of the control group was significantly higher than that of the observation group(P<0.05).After treatment,the body weight,triceps skin fold(TSF)and mid-arm muscle circumference(MAMC)of the two groups were significantly decreased,but the control group decreased more(P<0.05).Conclusion:Early hypotrophic nutrition support can significantly reduce the incidence of stress ulcer in patients with severe craniocerebral injury,improve gastric motility,prevent gastric juice pH from rising rapidly,improve nutritional index and increase the incidence of diarrhea.