血管内低温治疗联合早期幽门后喂养对首发重症缺血性脑卒中患者神经功能及预后的影响

Effects of intravascular hypothermia combined with early post-pyloric feeding on neurological function and prognosis in patients with first severe ischemic stroke

目的探讨血管内低温治疗联合早期幽门后喂养对首发重症缺血性脑卒中患者神经功能及预后的影响,旨在为临床决策首发重症缺血性脑卒中患者血管内低温治疗期最优营养支持策略提供理论依据。方法本研究为回顾性非随机对照研究,便利抽样法选取2018年1月至2021年12月入住首都医科大学宣武医院神经科ICU行血管内低温治疗的78例首发重症缺血性脑卒中患者为研究对象,收集患者一般信息和临床资料,根据血管内低温治疗联合不同营养支持方式分组,分为早期幽门后喂养组52例与早期肠外营养组26例,对2组患者神经功能预后、疾病预后、营养状况及营养支持相关并发症情况进行回顾性分析。结果早期幽门后喂养组血管内低温治疗后30 d格拉斯哥昏迷评分为(11.25±4.92)分,高于早期肠外营养组的(8.40±5.53)分,差异有统计学意义(t=-2.45,P<0.05);治疗后早期幽门后喂养组血清总蛋白、血红蛋白分别为(59.56±5.09)、(131.06±19.58)g/L,均高于早期肠外营养组的(56.52±7.94)、(122.07±17.72)g/L,差异均有统计学意义(t=-2.03、-1.91,均P<0.05);早期幽门后喂养组的临床肺部感染评分为(7.33±0.96)分,低于早期肠外营养组的(9.42±2.11)分,其机械通气时长及ICU住院时长分别为(17.46±10.47)、(28.89±12.59)d,少于早期肠外营养组的(25.77±15.20)、(37.07±17.15)d,差异均有统计学意义(t=3.28、2.83、2.52,均P<0.05);2组导管相关性血流感染及ICU住院死亡率比较差异均无统计学意义(均P>0.05)。结论血管内低温治疗联合早期幽门后喂养有助于改善首发重症缺血性脑卒中患者营养状况,有效控制肺部感染,缩短机械通气时间及ICU住院时长,促进患者神经功能修复。

Objective To investigate the effects of intravascular hypothermia combined with early post-pyloric feeding on the neurological function and prognosis in patients with severe ischemic stroke,and to provide a theoretical basis for clinical decision-making on the optimal nutritional support strategy for patients with severe ischemic stroke during intravascular hypothermia treatment.Methods This was a retrospective,non-randomized,controlled study.A total of 78 patients with first severe ischemic stroke who were admitted to the ICU of Neurology Department,Xuanwu Hospital,Capital Medical University from January 2018 to December 2021 were selected.General information and clinical data of the patients were collected and grouped according to intrvascular hypothermia combined with nutritional support.Patients were divided into early post-pyloric feeding group of 52 cases and early parenteral nutrition group of 26 cases.The neurological prognosis,disease prognosis,nutritional status and complications related to nutritional support of the two groups were retrospectively analyzed.Results The Glasgow score at 30th day after intravascular hypothermia in the early postpyloric feeding group was(11.25±4.92)points,which was higher than that in the early parenteral nutrition group(8.40±5.53),and the difference was statistically significant(t=-2.45,P<0.05).After treatment,the serum total protein and hemoglobin of early postpyloric feeding group were(59.56±5.09)g/L and(131.06±19.58)g/L,respectively,which were higher than those of early parenteral nutrition group(56.52±7.94)g/L and(122.07±17.72)g/L.The difference was statistically significant(t=-2.03,-1.91,P<0.05).The clinical pulmonary infection score of the early postpyloric feeding group was(7.33±0.96)points,which was lower than that of the early parenteral nutrition group(9.42±2.11).The mechanical ventilation time and ICU stay time were(17.46±10.47)days and(28.89±12.59)days,respectively.Compared with the early parenteral nutrition group(25.77±15.20)days and(37.07±17.15)days,the differences were statistically significant(t=3.28,2.83,2.52,all P<0.05).There were no significant differences in catheter-associated bloodstream infection and ICU hospitalization mortality between the two groups(both P>0.05).Conclusions Intravascular hypothermia combined with early post-pyloric feeding can improve the nutritional status of patients with severe ischemic stroke,effectively control pulmonary infection,shorten mechanical ventilation and hospital stay,and promote neurological repair.