经鼻饲及胃造瘘对脑卒中重度吞咽障碍患者吞咽功能、免疫功能及预后的影响比较

Comparison of effects of nasogastric feeding and gastrostomy on swallowing function,immune function and prognosis of patients with severe dysphagia after stroke

目的探讨经鼻饲及胃造瘘对脑卒中重度吞咽障碍患者吞咽功能、免疫功能及预后的影响。方法以我院2018年1月至2019年12月期间收治的80例脑卒中重度吞咽障碍患者作为研究对象采用区组随机化法分为对照组与试验组,每组各40例,对照组给予患者以鼻饲进行营养支持,试验组患者在此基础上并行胃造瘘进行营养支持,比较两组患者的吞咽功能、免疫功能及预后情况。结果治疗后,两组患者的吞咽功能均优于治疗前,但试验组的吞咽功能显著优于对照组(P<0.05);两组患者的TNF-α、hs-CRP、IL-2及IL-6水平均低于治疗前,但试验组的TNF-α、hs-CRP、IL-2及IL-6水平均显著低于对照组(P<0.05);试验组患者的肺部感染、低蛋白血症、消化道出血及电解质紊乱发生率均低于对照组(P<0.05)。结论针对脑卒中重度吞咽障碍患者应用胃造瘘术能够有效给予患者相应的肠内营养支持,促进其吞咽功能恢复,提升其免疫功能及预后效果。

Objective To explore the effects of nasogastric feeding and gastrostomy on swallowing function,immune function and prognosis of patients with severe dysphagia after stroke.Methods Eighty patients with severe dysphagia after stroke admitted to our hospital from January 2018 to December 2019 were selected.Patients were grouped using the bloke randomization method.After grouping,the control group and the experimental group had the same number of patients,with 40 patients in each group.The control group were given nasogastric feeding for nutritional support,and the experimental group were given nutritional support with nasogastric feeding and gastrostomy.The swallowing function,immune function and prognosis of the two groups were compared.Results The swallowing function was improved after treatment in both groups.The swallowing function of the experimental group was significantly better than that of the control group(P<0.05).The levels of TNF-α,hs-CRP,IL-2 and IL-6 were improved after treatment in both groups.The levels of NF-α,hs-CRP,IL-2 and IL-6 in the experimental group were significantly lower than those in the control group(P<0.05).The incidences of lung infection,hypoproteinemia,gastrointestinal bleeding and electrolyte imbalance in the experimental group were lower than those in the control group(P<0.05).Conclusion For patients with severe dysphagia after stroke,the application of gastrostomy can effectively provide corresponding enteral nutrition support,promote recovery of swallowing function,and improve immune function and prognosis.