NICU伴意识障碍脑卒中患者肠内营养支持的探讨  

Study of Enteral Nutrition Support in Acute Cerebral Stroke Patients With disturbance of consciousness in Neurological Intensive Care Unit(NICU)

作　　者：高萍[1] 董贯忠[1] 辛晋敏[1] 李妍[1] 

机构地区：[1]南京医科大学附属常州二院神经内科重症监护室,江苏常州213003

出　　处：《实用临床医药杂志》2011年第15期111-114,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨3种不同肠内营养支持对重症伴意识障碍脑卒中患者的营养状态和临床疗效的影响。方法将46例入住NICU的急性脑卒中患者随机分为EN(肠内高营养)组(14例)、EN(肠内高营养)+PN(肠外营养)组(16例)和普通膳食对照组(16例)给予营养支持。入院第1、14、21天分别检测患者营养指标的变化;治疗前和治疗后21 d检测患者T细胞亚群的变化;住院第1天、21天统计GCS评分、APACHEⅡ评分、NIHSS评分;统计患者住院期间并发症及21天病死率。结果各组在入院第14天、21天较第1天均出现TP、ALB、Hb的下降,普通膳食组下降更明显(P<0.05)。入院第21天EN组、EN+PN组TP、ALB、Hb指标优于普通膳食组,EN+PN组ALB、Hb指标优于EN组(P<0.05)。治疗后EN组、EN+PN组CD3+、CD4+、CD4+/CD8+淋巴细胞增殖较普食组高,EN+PN组CD3+水平高于EN组(P<0.05)。各组21 d GCS、APACHEⅡ、NIHSS评分较第1天明显改善,EN+PN组较普通膳食组NIHSS评分改善更为明显(P<0.05)。EN组、EN+PN组吸入性肺炎发生率较普通组明显减少,但EN组高血糖发生率增加,腹泻人数较多,而普通膳食组呕吐发生率较高(P<0.05)。3组相比病死率无明显差异(P>0.05)。结论重症脑卒中患者随病程延长,营养状况呈恶化趋势。肠内高营养可改善患者营养状况及预后,其中肠内+肠外营养联合疗法较单纯肠内高营养疗效更佳。Objective To explore the effect of three kinds of Enteral Nutritional（EN） support on nutritional status and clinical efficacy in acute cerebral stroke patients with disturbance of consciousness in Neurological Intensive Care Unit（NICU）.Methords Forty-six cases were randomly divided into three groups,that is EN（Enteral Nutrition） group（n=14）,EN＋PN（Parenteral-enteral Nutrition） group（n=16） and control group（n=16） who received normal liquid diet.The levels of hemoglobin（Hb）,serum albumin（ALB）,total protein（TP）and blood urea nitrogen（BUN） were detected at the 1st day,14th day and the 21st day.The subgroup of Tlymphocyte were observed respectively before treatment and 21days after treatment.Glasgow coma scale（GCS）,Acute Phisiology And Chronic Health Evaluation（APACHEⅡ）and Neurologic impairment score（NIHSS） were assessed at the 1st day and the 21st day after admission.The incidence of complications and mortality during the 21 days after stroke were studied.Results The nutritional index decreased at the 14th and 21st day after admission in three groups while more significantly lower in the control group（P0.05）.The content of TP,ALB,Hb in EN Group and EN＋PN group increased compaired with the control group at 21days after admission,while the levels of ALB,Hb is higher in EN＋PN group than in EN group（P0.05）.The levels of the CD3＋,CD4＋,CD4＋/CD8＋ in EN group and EN＋PN group were obviously higher than those of the control group.The levels of the CD3＋ in EN＋PN group was higher significantly than in EN group（P0.05）.The GCS,APACHEⅡ,NIHSS were improved in each group at 21day,while NIHSS was proved significantly in EN＋PN group than those in control group.The incidence of aspiration pneumonia was lower in EN group and EN＋PN group than in control group,but the incidence of hyperglycemia and diarrhea was higher in EN Group than in other two groups,while the incidence of vomit was higher in control group（P0.05）.There was no significant

关 键 词：脑卒中 意识障碍 肠内营养 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]