两种置管方式肠内营养治疗神经重症的疗效比较

Comparison of nasal jejunal nutrition tube and gastric tube in enteral nutrition for patients with severe neurosis

目的比较两种置管方式肠内营养(EN)治疗神经重症的临床疗效。方法选取2016年2月至2019年6月嘉兴市第二医院收治的85例神经重症患者为研究对象,在常规治疗原发病的基础上给予营养支持治疗;按随机数字表法分为两组并采用不同的EN置管方式,经留置鼻空肠营养管管饲42例(空肠管组),经留置胃管管饲43例(胃管组)。观察并比较两组患者治疗前及治疗10 d后实验室指标、意识障碍指标、机械通气时间、住院时间、并发症发生情况等。结果两组患者治疗前血尿素氮(BUN)、Hb、白蛋白(ALB)、格拉斯哥昏迷评分(GCS)、急性生理与慢性健康评分(APACHEⅡ)比较,差异均无统计学意义(均P>0.05);治疗10 d后,空肠管组Hb、ALB及GCS均明显高于胃管组(均P<0.05),BUN及APACHEⅡ均明显低于胃管组(均P<0.05)。空肠管组患者机械通气时间、住院时间均短于胃管组(均P<0.05)。空肠管组患者在治疗过程中误吸、反流等并发症发生率明显低于胃管组(14.3%比37.2%),差异有统计学意义(P<0.05)。结论对神经重症患者采用经留置鼻空肠营养管EN支持治疗,有利于在短时间内改善实验室指标,减少治疗过程中发生反流、误吸等并发症的风险,促进患者意识恢复,缩短病程。

Objective To compare nasal jejunal nutrition tube and gastric tube in enteral nutrition(EN)for patients with severe neurosis.Methods A total of 85 severe neurosis patients admitted to Jiaxing Second Hospital from February 2016 to June 2019 were enrolled.Nutritional support was given on the basis of conventional treatment of the primary cause.The EN was given via indwelling nasal jejunal nutrition tube in 42 cases(jejunal tube group),and via indwelling gastric tube in 43 cases(stomach tube group).The laboratory indicators,consciousness disturbance indicators,mechanical ventilation time,length of hospital stay,and complications were compared between two groups before and 10 days after treatment.Results Before treatment,there were no significant differences in blood urea nitrogen(BUN),Hb,albumin(ALB),Glasgow coma score(GCS),acute physiology and chronic health score(APACHEⅡ)between the two groups(all P>0.05).After 10 days of treatment,Hb,ALB and GCS in the jejunal tube group were significantly higher than those in the gastric tube group(all P<0.05),and BUN and APACHEⅡwere significantly lower than those in the gastric tube group(all P<0.05).The mechanical ventilation time and length of hospital stay of patients in the jejunal tube group were shorter than those in the gastric tube group(all P<0.05).The incidence of complications such as aspiration and reflux in the jejunal tube group was significantly lower than that in the gastric tube group(14.3%vs.37.2%,P<0.05).Conclusion The use of nasal indwelling jejunal tube in enteral nutrition can improve laboratory indicators,reduce the risk of complications during treatment,promote the recovery of consciousness and shorten the course of disease for critical neurosis patients.