肠内营养配合肠外营养对急危重症脑卒中患者营养状况及预后的影响

Effect of Enteral Nutrition combined with Parenteral Nutrition on Nutritional Status and Prognosis of Patients with Acute and Severe Stroke

目的探讨肠内营养配合肠外营养对急危重症脑卒中患者营养状况及预后的影响。方法回顾分析本院收治的80例急危重症脑卒中患者的临床病例资料,按照营养支持方式不同分为对照组、观察组,每组40例,分别采用单纯肠外营养、肠外营养联合肠内营养干预,两组患者均干预14 d,入院时及干预14 d时测定外周静脉血中营养状况指标[血清前白蛋白(PA)、白蛋白(ALB)、总蛋白(TP)],采用免疫比浊法检测体液免疫指标(血清IgA、IgM、IgG),采用格拉斯哥昏迷量表(GCS)评估患者昏迷程度,采用神经功能缺损评分(NIHSS评分)评价神经功能缺损情况,记录两组患者并发症发生情况。结果观察组治疗14 d时血清前白蛋白(PA)、白蛋白(ALB)、总蛋白(TP)均明显高于治疗前及对照组治疗后,P<0.05。观察组治疗14 d时血清IgA、IgG、IgM均明显高于治疗前及对照组治疗后,P<0.05。观察组治疗14 d时血清前GCS评分明显高于治疗前及对照组治疗后,P<0.05,NIHSS评分明显低于治疗前及对照组治疗后,P<0.05。观察组并发症发生率明显低于对照组,χ^(2)=5.165,P<0.05。结论肠内营养配合肠外营养在急危重症脑卒中患者应用能够更好改善患者营养状况,提高患者免疫功能,降低并发症发生率,改善短期预后。

Objective To investigate the effect of enteral nutrition combined with parenteral nutrition on nutritional status and prognosis of patients with acute and severe stroke.Methods The clinical data of 80 patients with acute and severe stroke admitted to our hospital were retrospectively analyzed,and they were divided into control group and observation group according to different nutritional support methods,with 40 cases in each group.Patients in both groups were treated with parenteral nutrition alone and parenteral nutrition combined with enteral nutrition intervention for 14 days.The nutritional status indicators of peripheral venous blood[serum prealbumin(PA),albumin(ALB),total protein(TP)]were measured at admission and 14 days after intervention.The humoral immune indicators(serum IgA,IgM,IgG)were detected by immunoturbidimetry.The Glasgow Coma Scale(GCS)was used to evaluate the degree of coma.The neurological deficit score(NIHSS)was used to evaluate the neurological deficit,and the complications of the two groups were recorded.Results The serum prealbumin(PA),albumin(ALB)and total protein(TP)in the observation group were significantly higher than those in the pretreatment and control group after 14 days,P<0.05.The serum IgA,IgG and IgM in the observation group were significantly higher than those in the pre-treatment and control group after treatment,P<0.05.The pre-serum GCS score in the observation group was significantly higher than that in the pre-treatment and control group after treatment,P<0.05,and the NIHSS score was significantly lower than that of before treatment and after treatment in the control group,P<0.05.The complication rate in the observation group was significantly lower than that in the control group,χ^(2)=5.165,P<0.05.Conclusions The application of enteral nutrition combined with parenteral nutrition in patients with acute and severe stroke can better improve the nutritional status of patients,improve the immune function of patients,reduce the incidence of complications,and improve the short-term prognosis.