肠内序贯营养支持在重症卒中患者中的应用研究  

Sequential enteral nutrition support for patients with severe cerebral stroke

作　　者：陈洁芳[1,2] 何旭东[1] 张力三[1] 胡兴越[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院神经内科,浙江杭州310016 [2]浙江丽水市中心医院神经内科,浙江丽水32300

出　　处：《浙江大学学报（医学版）》2013年第6期671-675,共5页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省中医药局青年基金资助项目(2006Y005);浙江省自然科学基金资助项目(Y2090184)

摘　　要：目的:探讨肠内序贯营养支持对重症卒中患者营养状况及并发症的影响。方法:将符合入组标准的49例患者随机分为序贯营养组(n=24)和常规营养组(n=25)。序贯营养组先采用短肽型肠内营养制剂,并逐步过渡到整蛋白型肠内营养制剂;常规营养组直接采用整蛋白型肠内营养制剂;比较两组患者的营养指标及并发症发生率。结果:住院期间两组患者各项营养指标均有下降,但与常规营养组相比,序贯营养组血红蛋白及血清白蛋白下降程度较轻,差异有统计学意义(P<0.05)。体重、体重指数、三头肌皮褶厚度、上臂围及上臂肌围两组之间无明显差异(P>0.05)。在并发症发生率方面,序贯营养组较常规营养组的感染率有下降,差异有统计学意义(P<0.05),胃肠道出血率亦有下降趋势。结论:与常规营养支持相比,肠内序贯营养支持可减轻重症卒中患者的营养状况恶化,降低感染等并发症的发生率,可能是重症卒中患者理想的营养支持方案。Objective： To evaluate the efficacy of sequential enteral nutrition support in patients with severe cerebral stroke. Methods： Forty-nine patients with severe cerebral stroke met the inclusion criteria were randomly divided into sequential enteral nutrition group （ Group A, n = 24） and conventional enteral nutrition group （Group B, n = 25 ）. Patients in Group A received short-peptide-based enteral nutrition support first,then gradually transferred to intact protein enteral nutrition. Meanwhile, patients in Group B constantly received intact protein enteral nutrition support. The nutritional indexes and the rate of complications were compared between two groups. Results： The nutritional indexes were decreased in both groups within 4 weeks after admission, but the decreasing levels of hemoglobin and albumin in Group A were significantly lower than those in Group B （ P 〈 0.05 ）, and the incidence of infections and gastrointestinal hemorrhage in Group A was also lower than that in Group B （ P 〈 0.05 ）. However, there were no significant differences in body weight, BMI, triceps skinfold thickness, biceps circumference, arm muscle circumference between two groups （ P 〉0. 05 ）. Conclusion： Sequential enteral nutritional support can improve the nutritional status and decrease the incidence of complications in critical patients with cerebral stroke.

关 键 词：危重病 卒中 预后 肠内序贯营养 肠道营养 重症卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]