摘要
目的 探究超早期肠内营养联合纤维支气管镜治疗对重症卒中相关性肺炎患者预后的影响。方法 回顾性研究2022年1月至2023年1月福建省漳州市医院神内介入重症监护室(ICU)符合卒中相关性肺炎诊断且行机械通气的120例患者临床资料,根据治疗方案不同分组,对照组(n=60)在发病24~48 h内给予肠内营养并按需吸痰,观察组(n=60)发病24 h内给予肠内营养,并行纤维支气管镜吸痰联合肺泡灌洗治疗。比较两组治疗前后血清炎症指标[白细胞(WBC)、降钙素原(PCT)、白介素-6(IL-6)]、抗生素使用天数、呼吸机使用天数、ICU住院天数以及患者预后情况、肠内营养相关不良反应发生率。结果 观察组患者治疗3、7、14 d后的血清WBC、PCT、IL-6低于对照组,差异有统计学意义(P <0.05)。观察组患者的抗生素使用天数、呼吸机使用天数、ICU住院天数短于对照组,差异有统计学意义(P <0.05)。两组治疗前的美国国立卫生研究院卒中量表(NIHSS)评分比较,差异无统计学意义(P> 0.05);观察组患者治疗14 d后NIHSS评分低于对照组,差异有统计学意义(P <0.05)。出院3个月后随访,观察组患者的预后良好占比高于对照组,差异有统计学意义(P <0.05)。两组患者的营养不耐受事件总发生率比较,差异无统计学意义(P> 0.05)。结论超早期肠内营养联合纤维支气管镜治疗重症卒中相关性肺炎能够快速控制炎症,缩短康复进程,并可更好改善患者预后。
Objective To explore the impact of ultra-early enteral nutrition combined with fiberoptic bronchoscopy treatment on the prognosis of severe stroke-associated pneumonia patients.Methods A retrospective study was conducted on the clinical data of 120 patients who were diagnosed as stroke-associated pneumonia and underwent mechanical ventilation in the intensive care unit(ICU) of Neurological Intervention,Zhangzhou Municipal Hospital of Fujian Province from January 2022 to January 2023.They were divided into different groups based on different treatment protocols.The control group(n=60) received enteral nutrition and aspirated sputum as needed within 24-48 hours of onset,while the observation group(n=60) received enteral nutrition within 24 hours of onset,and received fiberoptic bronchoscopy for sputum aspiration combined with alveolar lavage treatment.The serum inflammatory indicators(white blood cell [WBC],procalcitonin [PCT],interleukin-6 [IL-6]),the days of antibiotic use,ventilator use and ICU hospitalization,patient prognosis,and incidence of enteral nutritionrelated adverse reactions were compared between the two groups before and after treatment.Results After treatment for 3 days,7 days,and 14 days,the serum WBC,PCT,and IL-6 levels in the observation group were lower than those in the control group,with statistically significant differences(P < 0.05).The days of antibiotic use,ventilator use,and ICU hospitalization in the observation group were shorter than those in the control group,with statistically significant differences(P < 0.05).The National Institutes of Health stroke scale(NIHSS) score was compared between the two groups before treatment,without statistically significant difference(P > 0.05).After 14 days of treatment,the NIHSS score of patients in the observation group was lower than that of the control group,with statistically significant difference(P < 0.05).After 3 months of discharge,the follow-up showed that the proportion of patients with good prognosis in the observation group was higher than that in the control group,with statistically significant difference(P < 0.05).The total incidence of nutritional intolerance events was compared between the two groups of patients,without statistically significant difference(P > 0.05).Conclusion The ultra-early enteral nutrition combined with fiberoptic bronchoscopy in the treatment of severe stroke-associated pneumonia can quickly control inflammation,shorten the recovery process,and better improve patient prognosis.
作者
陈荣城
CHEN Rongcheng(Department of Neurological Intervention,Zhangzhou Municipal Hospital of Fujian Province,Fujian,Zhangzhou 363000,China)
出处
《中国医药科学》
2024年第3期186-190,共5页
China Medicine And Pharmacy
关键词
卒中相关性肺炎
纤维支气管镜吸痰
超早期肠内营养
营养不耐受
Stroke-associated pneumonia
Fiberoptic bronchoscopy for sputum aspiration
Ultra-early enteral nutrition
Nutritional intolerance
