脑卒中后吞咽障碍患者肠内营养联合肠外营养与全肠内营养支持的临床疗效比较  

Clinical efficacy of enteral nutrition combined with parenteral nutrition versus total enteral nutrition support in patients with dysphagia after stroke

作　　者：方少凡 胡文龙 黄东健[4] 

机构地区：[1]广州医科大学,广东广州511457 [2]广州市第一人民医院内科,广东广州511457 [3]佛山市顺德区第二人民医院内科,广东佛山528300 [4]广州医科大学第三附属医院重症医学科,广东广州510150

出　　处：《中国临床研究》2018年第1期98-101,共4页Chinese Journal of Clinical Research

摘　　要：目的比较肠内营养联合肠外营养与全肠内营养支持对于脑卒中后吞咽障碍患者的临床疗效和安全性。方法选择2011年1月至2014年12月在神经内科住院治疗的45例脑卒中后吞咽障碍患者,随机分为肠内营养联合肠外营养组(EN+PN组,n=21)和全肠内营养组(EN组,n=24)。营养支持的目标热量为25 kcal·kg-1·d-1。检测并比较两组患者的血清总蛋白、白蛋白、前白蛋白水平及氮平衡情况。结果入院后,两组患者的血清白蛋白水平随治疗时间延长逐渐降低。EN组在第5天降至最低点,EN+PN组在第7天降至最低点。在第13天时,两组患者血清白蛋白水平均较最低点明显升高(P均<0.05),且EN+PN组水平高于EN组(P<0.05)。EN组入院第3天血清前白蛋白降至最低,与入院第1天比较,差异有统计学意义(P<0.05);EN+PN组在第5天降至最低,与入院第1天比较,差异有统计学意义(P<0.05)。在第13天时,两组患者血清PA水平均较最低点升高(P均<0.05),EN+PN组血清前白蛋白水平明显高于EN组(P<0.05)。两组患者入院后营养状况呈负氮平衡,以第5~9天最为明显,但EN+PN组氮平衡值在第5~13天明显高于EN组(P均<0.05)。结论对于脑卒中后吞咽障碍患者,肠内营养联合肠外营养比单纯的肠内营养临床效果更好。Objective To compare the clinical efficacy and safety of enteral nutrition combined with parenteral nutrition and total enteral nutrition support in patients with post-stroke dysphagia. Methods Forty-five patients with dysphagia after stroke were selected from January 2011 to December 2014 and were randomly divided into enteral nutrition combined with parenteral nutrition group （ EN ＋ PN group, n = 21 ） and total enteral nutrition group （ EN group, n = 24 ）. The goal of nutritional support was 25 kcal·kg^-1·d^-1. The levels of total protein （TP）, serum albumin （ALB）, serum prealbumin （PA） and nitrogen balance were detected and compared between two groups. Results After admission, the serum albumin levels decreased gradually in both two groups and dropped to the lowest point on the fifth day in EN group and on the seventh day in EN ＋ PN group. At the 13th day, the serum albumin level significantly increased compared with the lowest point in both two groups and was statistically higher in EN ＋ PN group than that in EN group （ P 〈 0. 05 ）. Serum prealbumin obviously decreased to the lowest point at the 3th day compared with the lth day ＇after admission in EN group （P 〈 0.05 ）and decreased to the the lowest point at the 5th day compared with the l th day after admission in EN ＋ PN group （P 〈 0.05 ）. At 13th day, the serum PA level significantly increased compared with the lowest point of PA in both two groups（all P 〈 0. 05 ） and was statistically higher in EN ＋ PN group than that in EN group （ P 〈 0.05 ）. Stress and endocrine hormone levels showed negative nitrogen balance after admission in both two groups and was the most obvious at the 5th day to 9th day. In reducing nitrogen loss, EN ＋ PN group was significantly better than EN group （ all P 〈 0.05 ）. Conclusion For patients with dysphagia after stroke, the clinical effect of enteral nutrition combined with parenteral nutrition is better than that of simple enteral nutrition.

关 键 词：脑卒中 吞咽障碍 营养状态 肠内营养 肠外营养 氮平衡 总蛋白 白蛋白 前白蛋白 

分 类 号：R459.3[医药卫生—治疗学]