脑卒中后吞咽障碍患者行含益生菌肠内营养支持的疗效观察

Efficacy of enteral nutrition support with probiotics in patients with swallowing disorders after cerebralvascular accident

背景营养不良是脑卒中(cerebralvascular accident,CVA)患者预后不良的独立危险因素,但单纯肠内营养支持难以保证营养物质的及时消化吸收,而含益生菌肠内营养支持是改善胃肠道功能,提高营养物质吸收的有效手段,可用于脑卒中后吞咽障碍患者.目的探讨CVA后吞咽障碍患者含益生菌肠内营养支持疗效.方法选取2017-09/2020-10我院脑卒中后吞咽障碍患者106例,以随机数字表法分为观察组(n=53)、对照组(n=53).对照组采取常规肠内营养支持,观察组采取含益生菌肠内营养支持,均治疗2 wk.比较两组治疗前、治疗1 wk、2 wk后营养参数[血红蛋白(hemoglobin,Hb)、白蛋白(albumin,ALB)、总蛋白(total protein,TP)]、免疫功能指标[外周血总淋巴计数(total lymphocyte count,TLC)与血清免疫球蛋白M(immunoglobulin M,IgM)、免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白A(immunoglobulin A,IgA)]、美国国立卫生院神经功能缺损量表(national institutes of health neurological deficit scale,NIHSS)、急性生理学及慢性健康状况评分系统Ⅱ(acute physiology and chronic health scoring systemⅡ,APACHEⅡ)评分、肠道屏障功能指标[二胺氧化酶(diamine oxidase,DAO)、D-乳酸(D-lactic acid,D-LA)]水平,并统计胃肠道并发症发生情况、住院时间、住院费用.结果观察组治疗1 wk、2 wk后外周血TLC与血清IgM、IgG、IgA、Hb、ALB、TP水平均高于对照组(P<0.05);观察组治疗1 wk、2 wk后NIHSS、APACHEⅡ评分及血清DAO、D-LA水平均低于对照组(P<0.05);观察组住院时间短于对照组,胃肠道并发症发生率及住院费用低于对照组(P<0.05).结论含益生菌肠内营养支持应用于脑卒中后吞咽障碍患者中,可有效减少胃肠道并发症发生,改善患者营养状态及免疫功能,促进肠道屏障功能恢复,缩短康复进程,且医疗费用较低,值得临床推广与应用.

BACKGROUND Malnutrition is an independent risk factor for poor prognosis of cerebralvascular accident(CVA)patients,but it is difficult to ensure timely digestion and absorption of nutrients by simple enteral nutrition support,while enteral nutrition support with probiotics is an effective means to improve gastrointestinal function and nutrient absorption,which can be used for patients with dysphagia after stroke.AIM To evaluate the efficacy of enteral nutrition support containing probiotics in patients with swallowing disorders after CVA(stroke).METHODS A total of 106 patients with dysphagia after stroke treated at our hospital from September 2017 to October 2020 were selected and divided into either an observation group(n=53)or a control group(n=53)by the random number table method.The control group received routine enteral nutrition support,and the observation group received enteral nutrition support with probiotics.Both groups were treated for 2 wk.Nutritional parameters[hemoglobin(Hb),albumin(ALB),and total protein(TP)],immune function indexes[total lymphocyte count(TLC)in peripheral blood and serum immunoglobulin(Ig)M,IgG,and IgA],National Institute of Health stroke scale(NIHSS)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,and intestinal barrier function indexes[diamine oxidase(DAO)and D-lactic acid(D-LA)]before treatment and at 1 wk and 2 wk after treatment were compared between the two groups.The occurrence of gastrointestinal complications,hospital stay,and hospital expenses were recorded.RESULTS The levels of peripheral blood TLC and serum IgM,IgG,IgA,Hb,ALB,and TP in the observation group were significantly higher than those in the control group after 1 and 2 wk of treatment(P<0.05).NIHSS score,APACHEⅡscore,and serum DAO and D-LA levels in the observation group were significantly lower than those in the control group after 1 and 2 wk of treatment(P<0.05).The length of hospital stay in the observation group was shorter than that in the control group,and the incidence of gastrointestinal complications and hospitalization expenses were lower than those in the control group(P<0.05).CONCLUSION The application of enteral nutrition support with probiotics in patients with dysphagia after stroke can effectively reduce the occurrence of gastrointestinal complications and improve the nutritional status and immune function of patients,promote the recovery of intestinal barrier function,shorten the rehabilitation process,and has low medical costs.