脑卒中合并吞咽功能障碍的老年病人序贯肠内营养支持治疗的研究  

Research of sequential enteral nutrition support therapy in elderly stroke patients with dysphagia

作　　者：范隽韵 单廷[2] 葛婷婷[1] 康宏伟[1] FAN Juan-yun SHAN Ting GE Ting-ting KANG Hong-wei(Department of Rehabilitation Department of General Surgery, Wuxi Second Hospital, Nanfing Medical University, Wuxi 214002, Jiangsu , China)

机构地区：[1]南京医科大学附属无锡第二医院康复医学科,江苏无锡214002 [2]南京医科大学附属无锡第二医院普通外科,江苏无锡214002

出　　处：《肠外与肠内营养》2016年第5期293-296,共4页Parenteral & Enteral Nutrition

摘　　要：目的:探讨序贯肠内营养(EN)支持治疗在脑卒中合并吞咽功能障碍老年病人治疗中的应用和临床效果。方法:将62例急性缺血性脑卒中合并吞咽功能障碍的老年病人随机分为研究组和对照组。研究组(n=32)病人给予短肽型EN制剂,逐步过渡至整蛋白型EN制剂的序贯EN治疗方案。对照组(n=30)病人直接给予整蛋白型EN制剂。观察两组病人入组第1和第14天的营养指标、免疫功能指标和神经功能缺损评分(NIHSS)的变化以及并发症的发生情况。结果:入组第14天,两组病人的营养指标、免疫功能指标和NIHSS评分均较第1天明显下降(P<0.05)。研究组与对照组比,营养指标和免疫功能指标下降的程度均较轻(P<0.05),NIHSS评分下降程度无显著性差异(P>0.05)。研究组病人总并发症的发生率少于对照组(P<0.05)。结论:序贯EN支持治疗能减轻脑卒中合并吞咽功能障碍的老年病人营养不良发展程度和免疫功能下降程度,促进神经功能恢复,降低并发症发生的风险。Objective ： To evaluate the feasibility and clinical effect of sequential enteral nutrition therapy in elderly stroke patients with dysphagia. Methods： Sixty-two elderly patients of acute ischemic stroke with dysphagia were randomly divided into two groups, 32 patients in the research group were treated with sequential enteral nutrition therapy in which transformed gradually from short-peptide to totalprotein enteral nutrition, while the other 30 patients in the control group were treated with total-protein enteral nutrition immediately after initiation of enteral nutrition. All patients were assessed with the changes of nutritional indicators, immune index, National Institute of Health Stroke Scale （NIHSS） and the complications at admission, 2 weeks after admission respectively. Results ： After 2 weeks with enteral nutrition, the levels of nutritional indicators, immune index and NIHSS score decreased in both groups. The descending levels of nutritional indicators, immune index in the research group were significantly lower than in the control group （P 〈 0.05 ）. There was no significant difference in the descending levels of NIHSS score. The incidence of complications in the research group were significantly lower than those of the control group （ P 〈 0.05 ）. Conclusion ： The sequential enteral nutrition therapy can alleviate the degree of malnutrition, reduce the extent of the decline in immune function, improve the neurological function and reduce the incidence of complications in elderly stroke patients with dysphagia.

关 键 词：脑卒中 吞咽功能障碍 序贯肠内营养 

分 类 号：R459.3[医药卫生—治疗学] R743.32[医药卫生—临床医学]