神经重症患者留置鼻胃管或鼻肠管进行肠内营养的效果比较

Analysis of the effect of indwelling nasogastric or nasoenteral tubes for enteral nutrition in patients with neurological intensive care

目的探讨神经重症患者分别经鼻胃管和鼻肠管两种方式进行肠内营养支持的疗效。方法收集2020年1月至2022年1月入住遵义医科大学附属医院神经重症监护室142例进行肠内营养支持患者的临床资料,其中70例患者给予鼻胃管管饲,为A组,72例患者给予鼻肠管管饲,为B组。分别比较两组患者肠内营养支持前、支持10 d后营养指标(血清总蛋白、血清白蛋白、血清前白蛋白)以及胃肠道并发症(腹泻、胃潴留、胃黏膜出血)发生率和预后。结果营养状况:肠内营养10 d后,B组患者营养指标(总蛋白、白蛋白、前白蛋白)水平均明显提高,差异有统计学意义(P<0.001);A组患者血清总蛋白水平显著升高,差异有统计学意义(P<0.05),而白蛋白、前白蛋白水平无明显变化,差异无统计学意义(P>0.05);营养支持10 d后进行两组组间比较发现,B组各营养指标改善情况均优于A组,差异有统计学意义(P<0.001)。肠道并发症:B组患者胃潴留、腹泻及胃黏膜出血发生率明显低于A组,差异均有统计学意义(P<0.05)。影响预后指标:B组新发肺部感染率、呼吸机使用时间、抗生素使用时间、急性生理与慢性健康评分(acute physiology and chronic health evaluation,APACHEⅡ)明显优于A组,差异均有统计学意义(P<0.05);住院时间两组间比较差异无统计学意义(P>0.05)。结论与经鼻胃管加强营养比较,经鼻肠管途径提高神经重症患者营养指标效果较为显著,能降低并发症发生率,缩短抗生素使用时间,可能对患者预后有所改善。

Objective To investigate the effect of enteral nutrition support by nasogastric intubation and nasoenteral tube in patients with severe neurological diseases.Methods Retrospective analysis was made on the clinical data of 142 cases who were treated in the Neuro Intensive Care Unit of the Affiliated Hospital of Zunyi Medical University for enteral nutrition support from January 2020 to January 2022.70 patients were given Nasogastric intubation feeding,which was group A,and 72 patients were given nasoenteral tube feeding,which was group B.Compare the nutritional improvement(Total serum protein,serum albumin,and serum prealbumin)before and after 10 days of enteral nutrition support,as well as the incidence of gastrointestinal complications(Diarrhea,gastric retention,gastric mucosal bleeding)and prognosis between the two groups.Results Nutritional status:After 10 days of enteral nutrition,the levels of serum total protein,serum albumin,and serum prealbumin in Group B patients were significantly improved(P<0.001).The serum total protein levels of patients in Group A were significantly increased(P<0.05),however,there was no significant change in the levels of serum albumin and prealbumin(P>0.05);The overall nutrition states in Group B was superior to Group A(P<0.001).Intestinal complications:the incidence of gastric retention,diarrhea and gastric mucosal bleeding in group B was obviously less than that in group A(P<0.01).(3)Prognostic indicators:Pulmonary infection;the duration of ventilator use;antibiotic usage time;The Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score in Group B were apparently better those in Group A(P<0.05);There was no significant difference in total hospital days between the two groups of patients(P>0.05).Conclusion Compared with enteral nutrition via Nasogastric intubation,enteral nutrition via nasoenteral tube is helpful to improve nutritional indicators of patients with severe neurological diseases,reduce the incidence of complications,shorten the course of disease,and possibly improve the prognosis of patients.