早期干预促进颅内出血患者经口营养：回顾性队列研究  

Early intervention to promote oral feeding in patients with intracerebral hemorrhage： a retrospective cohort study

作　　者：罗青扬[1] 陈炜[1] 朱伟一[1] 徐伟[2] 

机构地区：[1]复旦大学附属华山医院静安分院神经外科,上海市200040 [2]复旦大学附属华山医院神经外科,上海市200040

出　　处：《老年医学与保健》2012年第3期159-162,共4页Geriatrics & Health Care

摘　　要：目的本项目旨在评价急性颅内出血患者早期加强口腔护理和经口营养的可行性，风险和临床结果。方法回顾性分析2002年-2009年收住我院的自发性颅内出血病例219例。经口营养的早期干预项目，包括加强口腔护理和早期行为学干预，自2005年4月引进，至2006年1月全面开展。结果由2005年1月后收人的129例组成的早期干预组和由2002年1月后收入的90例组成的对照组之间比较。结果可以耐受经口营养患者的比例，早期干预组显著比对照组高（112／129（86．8％）vs61／90（67．8％）；OR3．13，95％CI，1．59-6．15；P〈O．001）。经校正基线水平后，OR值为4．42（95％CI，1．81-10．8；P=0．001）。肺部感染的发生率在早期干预组中比控制组低（27／129（20．9％）vs．32／90（35．6％），优势比为0．48，95％CI，0．26-0．88；P=0．016）。log-rank试验发现停用营养支持所需时间在两组间有显著性差异（危害比为1．94，95％CI，1．46-2．71；P〈0．001）。结论急性颅内出血患者早期应当加强口腔护理和经口营养技术的安全性和可行性。Objective The purpose of this study is to establish the feasibility, risks and clinical outcomes of early intensive oral care and oral feeding in patients with an acute intracerebral hemorrhage （ICH）. Methods A total of 219 patients with spontaneous ICH who were admitted to our institution from 2002 to 2009 were retrospectively analyzed. An early intervention program for oral feeding, which consisted of intensive oral care and early behavioral interventions, was introduced from April 2005 and fully operational by January 2006. Outcomes were compared between an early intervention group of 129 patients recruited after January 2005 and a historical control group of 90 patients recruited after January 2002. A logistic regression technique was used to adjust for baseline differences between the groups. To analyze time to attain oral feeding, the Kaplan-Meier method and C44ox proportional hazard model were used. Results The proportion of patients who could tolerate oral feeding was significantly higher in the early intervention group compared with the control group （112/129 （86.8%） vs. 61/90 （67.8%）; odds ratio 3.13, 95%CI, 1.59-6.15; P〈0.001）. After adjusting for baseline imbalances, the odds ratio was 4.42 （95% CI, 1.81-10.8; P= 0.001）. The incidence of chest infection was lower in the early interventiongroupcomparedwiththecontrolgroup （27/129 （20.9%） vs. 32/90 （35.6%）; odds ratio0.48, 95% CI, 0.26-0.88; P=0.016）. A log-rank test found a significant difference in nutritional supplementation-free survival between the two groups （hazard ratio 1.94, 95% CI, 1.46-2.71; P〈 0.001）. Conclusion Our data suggest that the techniques of early intervention to promote oral feeding can be used safely and possibly with enough benefit to the patients with intracerehral hemorrhage.

关 键 词：脑出血 经口营养 早期干预 

分 类 号：R651[医药卫生—外科学]