脑卒中并发吞咽功能障碍老年病人肠内营养支持的临床研究  

Clinical research of enteral nutrition therapy in elderly stroke patients with dysphagia

作　　者：张丽[1] 林兴建[1] 陈道文[1] 余年[1] 张书刚[1] 

机构地区：[1]南京医科大学附属脑科医院神经内科,江苏南京210029

出　　处：《肠外与肠内营养》2014年第5期292-294,297,共4页Parenteral & Enteral Nutrition

摘　　要：目的:探讨脑卒中并发吞咽障碍老年病人进行肠内营养(EN)支持前后营养状况指标、耐受性、感染并发症以及短期预后的情况。方法:选取128例急性脑卒中并发吞咽困难的老年病人,根据入院营养支持方式分为治疗组(n=80)和对照组(n=48)。治疗组再根据营养液的种类分为瑞先组(n=44)和能全力组(n=36),对照组病人为普通鼻饲饮食。病人于入院当天、EN支持第14天和出院时采用美国国立卫生研究院卒中量表(NIHSS)进行神经功能评分,并观察营养指标、并发症以及短期临床预后情况。结果:治疗组病人EN支持第14天以及出院时的NIHSS评分均低于对照组,肺部感染发生率降低,住院时间短于对照组,营养状况优于对照组,差异均有统计学意义(P<0.05)。同时,瑞先与能全力由于膳食纤维成分配比不同,两组病人便秘和腹泻的发生率均有显著性差异(P<0.05)。结论:急性脑卒中并发吞咽功能障碍的老年病人早期EN支持(瑞先)有利于病人神经功能和营养指标的恢复,降低肺部感染发生率,改善病人短期的预后。Objective：To evaluate the nutrition index,tolerance,infectious complications and short-term prognosis in stroke patients with dysphagia before and after enteral nutrition （EN） therapy.Methods：128 elderly patients of acute stroke accompanied with dysphagia were divided into the treatment group （n =80） and control group （n =48） according to the nutritional supporting methods.The treatment group was divided into enteral nutritional emulsion （TPF） group （n =44） and nutrison fibre （NF） group （n =36）,while the control group was treated with general nasal feeding diet.Neurological scores of patients were tested by National Institute of Health Stroke Scale （NIH Stroke Scale,NIHSS） at admission,14 days after admission and discharge respectively,and the changes of nutritional indicators and the complications were observed simultaneously.Results：At day 14 and discharge,the NIHSS score and incidence of lung infection in treatment group were significantly lower than those of the control group （P ＜ 0.05）,the time of hospital stay was less,and the nutrition indicators in treatment group were also significantly improved than those of the control group.Meanwhile,because of the different sources of dietary fiber,the incidences of constipation and diarrhea in TPF and NF groups were significantly different （P ＜ 0.05）.Conclusion：Early EN support can improve the acute neurological function,nutrition indicator,short-term prognosis,and reduce the incidence of infectious complication in the elderly stroke patients with dysphagia.

关 键 词：脑卒中 吞咽功能障碍 肠内营养 

分 类 号：R743.35[医药卫生—神经病学与精神病学] R459.3[医药卫生—临床医学]