早期幽门后肠内营养联合早期气管切开在老年重型颅脑损伤机械通气患者中的应用

CLINICAL VALUE OF EARLY PYLORIC POSTERIOR ENTERAL NUTRITTION COMBINED WITH EARLY TRACHEOTOMY IN ELDERLY PATIENTS WITH MECHANICAL VENTION IN ELDERLY PATIENTS WITH SEVERE CRANIOCEREBRAL INJURY

目的 分析早期幽门后肠内营养联合早期气管切开对老年重型颅脑损伤机械通气患者中的应用效果。方法 选取该院2020年2月—2022年2月收治的老年重型颅脑损伤昏迷患者125例,按治疗方式的不同分为观察组63例,即早期行幽门后肠内营养及早期气管切开的老年重型颅脑损伤机械通气患者;对照组62例,即普通经鼻饲管肠内营养及气管插管的老年重型颅脑损伤机械通气患者。观察二组患者经不同部位肠内营养处理,不同改善气道通气处理后两周患者营养指标变化(总蛋白,血清白蛋白);动脉血氧分压(PaO_(2))、血氧饱和度(SaO_(2))、二氧化碳分压(PCO_(2)),并发症发生率(获得性肺炎,反流误吸,呕吐,腹泻,消化道出血,病死率);机械通气时间、再次使用呼吸机率及ICU住院时间。结果 通过二组不同方式治疗后,观察组总白蛋白、血清白蛋白水平明显好于对照组,差异有统计学意义(P<0.05)。观察组患者PaO_(2)、SaO_(2)显高于对照组患者,而PCO_(2)明显低于对照组,差异有统计学意义(P<0.05)。观察组各种并发症发生率均低于对照组,差异有统计学意义(P<0.05)。观察组治疗后机械通气时间、ICU治疗时间以及再次使用呼吸机率明显低于对照组,差异均有统计学意义(P<0.05)。结论 早期幽门后肠内营养联合早期气管切开可以提高老年颅脑损伤昏迷患者的营养状况,改善肺部缺氧情况,降低营养支持及气道治疗相关并发症发生率,缩短机械通气时间、ICU治疗时间及再次使用呼吸机率,从而从整体上提高治疗的疗效。

Objective To analyze the value of early posterior pyloric enteral nutrition combined with early tracheotomy for mechanical ventilation in elderly patients with severe head injury.Methods We selected one hundred and twenty five elderly patients with severe craniocerebral injury and coma admitted to our hospital from February 2020 to February 2022,According to the treatment according to the different treatment modeThe observation group included sixty-three elderly patients with mechanical ventilation after severe craniocerebral injury who received early retropyloric enteral nutrition and early tracheotomy, and the control group included sixty-two elderly patients with mechanical ventilation after severe craniocerebral injury who received ordinary enteral nutrition through nasal feeding tube and tracheal intubation.After different enteral nutrition treatments at different positions and different improved airway ventilation treatments for one week, we observed the changes of nutritional indexes(total protein, serum albumin),arterial partial pressure of oxygen(PaO_(2)),oxygen saturation(SaO_(2)),partial pressure of carbon dioxide(PCO_(2)),incidence of complications(acquired pneumonia, reflux aspiration, vomiting, diarrhea, gastrointestinal bleeding, mortality);duration of mechanical ventilation, rate of re-use breathing, and length of ICU stay in two groups.Results After treatment in two groups, the levels of total albumin and serum albumin in the observation group were significantly betterthan those in the control group, with statistical significance(P<0.05).PaO_(2)and SaO_(2)in observation group were significantly higher than those in control group, while PCO_(2)was significantly lower than control group, the difference was statistically significant(P<0.05).The incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05).After treatment, mechanical ventilation time, ICU treatment time and re-use respiratory rate in the observation group were significantly lower than those in the control group, with statistical significance(P<0.05).Conclusion Early enteral nutrition after helicobacter joint early tracheotomy can improve the nutritional status of elderly patients with craniocerebral injury coma, improve pulmonary hypoxia condition, reduce the incidence of nutritional support and airway treatment-related complications, shorten the time of mechanical ventilation, ICU treatment time and again used breathing chances, so as to improve the therapeutic efficacy of treatment as a whole.