摘要
目的评估胃管减压联合鼻肠管营养支持对重症神经系统疾病患者预后的影响。方法将90例患者分为鼻肠管组和鼻胃管组,每组各45例。收集两组患者入组时急性病生理学和长期健康评价(APACHE)Ⅱ评分及格拉斯哥昏迷评分(GCS);收集每例患者治疗后1、7、14 d白蛋白水平及肠内营养热卡;记录并比较各组患者并发症的发生情况及机械通气时间、ICU住院时间、总住院时间、病死率情况。结果鼻肠管组及鼻胃管组患者APACHEⅡ评分[(20.5±6.4)分vs.(20.3±6.9)分]、GCS评分[(6.1±1.3)分vs.(5.5±1.5)分]间比较,差异均无统计学意义(t=0.140、0.270,P=0.888、0.787)。鼻肠管组患者治疗后14 d的血白蛋白水平[(37.5±2.8)g/L vs.(34.2±5.6)g/L]及获得肠内营养热卡[(2 147±625)kcal vs.(1 791±768)kcal]较鼻胃管组显著升高(t=3.548、2.412,P=0.001、0.017)。同时,鼻肠管组患者吸入性肺炎(5/45 vs.20/45)、营养液潴留(3/45 vs.19/45)的发生率显著低于鼻胃管组患者(χ~2=12.462、15.401,P=0.001、0.001)。而两组患者在机械通气时间(t=1.149,P=0.253)、ICU住院时间(t=0.763,P=0.447)、总住院时间(t=1.251,P=0.214)及病死率(χ~2=0.403,P=0.525)的比较,差异均无统计学意义。结论对于重症神经系统患者早期进行胃管减压联合鼻空肠管营养更能有效改善其营养状况、减少并发症的发生,对改善患者预后有一定的临床价值。
Objective To evaluate the effect of nasogastric tube decompression combined with nasointestinal tube nutritional support in the prognosis of patients with severe nervous system diseases. Methods A total of 90 patients with severe nervous system diseases were divided into the nasointestinal tube group （n = 45） and the nasogastric tube group （n = 45）. The acute physiology and chronic health evaluation （APACHE） 11 and Glasgow coma scale （CCS） were calculated after the patients were recruited into the groups. The levels of albumin and calories gained from enteral nutrition were determined on 1, 7, 14 d after treatment. Theincidence of complications, duration of mechanical ventilation, length of ICU stay, total length of hospital stay and mortality rate were also recorded and compared between these two groups. Results The APACHE I1 scores [（20.5 ＋ 6.4）vs. （20.3 ＋ 6.9）] and GCS scores [（6.1 ＋ 1.3） vs. （5.5 _＋ 1.5）] all showed no significant differences in the nasointestinal tube group and the nasogastric tube group （t = 0.140, 0.270; P = 0.888, 0.787）. The levels of albumin [（37.5 ＋ 2.8） g / L vs. （34.2 -＋ 5.6） g / L] and calories gained from enteral nutrition [（2 147 ＋ 625） kcal vs. （1 791 ＋ 768）kcal] on 14 d after treatment in the nasointestinal tube group were both much higher than those in the nasogastric tube group （t = 3.548, 2.412; P = 0.001, 0.017）. Meanwhile, the incidence of aspiration pneumonia （5/45vs. 20/45） and nutrient fluid retention （3/45vs. 19/45） in the nasointestinal tube group were much lower than those in the nasogastric tube group （X2 = 12.462, 15.401; P= 0.001, 0.001）. However, there were no significant differences in the duration of mechanical ventilation （t = 1.149, P = 0.253）, length of ICU stay （t = 0.763, P = 0.447）, total length of hospital stay （t = 1.251, P = 0.214） and mortality rate （X2 = 0.403, P = 0.525） between the two groups. Conclusion Nasogastric tube decompression combined with nasointestinal tube nutritional support at the early stage can improve nutritional status and reduce complications in patients with severe nervous system diseases.
出处
《中华危重症医学杂志（电子版）》
CAS
CSCD
2017年第4期230-234,共5页
Chinese Journal of Critical Care Medicine:Electronic Edition
基金
浙江省温州市科技计划项目(Y20140077)
关键词
营养支持
肠道营养
神经系统疾病
预后
Nutritional support
Enteral nutrition
Nervous system diseases
Prognosis
