鼻胃管营养与空肠营养在神经重症患者中的疗效比较

Comparison of Curative Effect between Nasogastric Tube Nutrition and Jejunal Nutrition in Patients with Severe Neurological Diseases

目的探索鼻胃管营养和空肠营养对神经重症患者住院期间并发症及病死率的影响。方法回顾性分析2020年6月~2022年6月武汉市第四医院重症医学科收治的因神经重症住院患者的临床资料。根据肠内营养方式分为鼻胃管营养组和空肠营养组,采用倾向性评分匹配(propensity score matching,PSM)均衡两组基线资料,比较两组患者住院期间并发症、病死率、住院费用和平均住院时长的差异。结果PSM后,两组基线资料比较,差异均无统计学意义(P>0.05)。鼻胃管营养组和空肠营养组的神经重症患者并发症发生率、病死率比较,差异均无统计学意义(P>0.05)。进一步单因素和多因素Logistic回归分析结果显示,年龄(OR=1.036,P=0.017),急性生理和慢性健康状况Ⅱ评分(APACHEⅡ评分,OR=1.147,P<0.001)和血尿素氮水平(OR=1.135,P=0.001)可能是影响该类患者预后的关键因素。结论肠内营养方式对于神经重症患者住院期间并发症发生率和病死率无显著影响,老年患者、较高的APACHEⅡ评分以及血尿素氮水平是神经重症患者住院期间死亡的独立危险因素。

Objective To explore the effects of nasogastric tube nutrition and jejunal nutrition on the complications and mortality in severe neurological diseases during hospitalization.Methods The clinical data of patients with severe neurological diseases admitted to Department of Intensive Care Unit,Wuhan Fourth Hospital from June 2020 to June 2022 were analyzed retrospectively.Patients were divided into nasogastric tube nutrition group and jejunal nutrition group according to enteral nutrition methods.The propensity score matching(PSM)was used to equalize the baseline data of the two groups,and the differences in complications,mortality,hospitalization costs,and mean length of stay between two groups were compared.Results There were no significant differences in baseline data between the two groups after PSM(P>0.05).There were also no significant differences in complication rate and mortality between the nasogastric tube nutrition group and the jejunal nutrition group(P>0.05).Further univariate and multivariate regression Logistic analysis showed that age(OR=1.135,P=0.001),acute physiology and chronic health evaluationⅡscore(APACHEⅡscore,OR=1.147,P<0.001)and blood urea nitrogen level(OR=1.135,P=0.001)might be the key factors affecting the prognosis of patients with severe neurological diseases.Conclusion Enteral nutrition had no significant effect on the incidence of complications and mortality during hospitalization in patients with severe neurocritical diseases,elderly patients,higher levels of APACHEⅡscore and blood urea nitrogen were independent risk factors for mortality patients with severe neurological diseases.