肠内营养序贯治疗对重症急性脑梗死合并吞咽功能障碍患者营养状态和预后的影响  

Effect of sequential enteral nutrition on nutritional status and prognosis of patients with severe acute cerebral infarction complicated with dysphagia

作　　者：韩琳[1] 李笑蕾[1] Han Lin;Li Xiaolei(Department of Neurology,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院神经内科,长春130033

出　　处：《中国医学前沿杂志（电子版）》2020年第4期89-93,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的观察肠内营养序贯治疗对重症急性脑梗死(acute cerebral infarction,ACI)合并吞咽功能障碍患者营养状态和预后的影响。方法选取吉林大学中日联谊医院2016年6月至2018年6月收治的96例重症ACI合并吞咽功能障碍患者为研究对象,按照随机数字表法将其分为对照组和观察组,每组各48例。给予对照组患者常规肠内营养治疗,给予观察组患者肠内营养序贯治疗。治疗14 d后,比较两组患者血清白蛋白、前白蛋白、血红蛋白水平和低蛋白血症、感染性并发症和不良反应发生率。治疗28 d后,比较两组患者营养状态[非瘫痪侧肱三头肌皮褶厚度(triceps skinfold thickness,TSF)、上臂肌围(mid-arm muscle circumference,MAMC)]和预后[美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、Barthel指数(Barthel index,BI)评分]。结果治疗14 d后,对照组患者血清白蛋白、前白蛋白水平均显著低于本组治疗前(均P<0.05),观察组患者前白蛋白水平显著高于本组治疗前(P<0.05),且观察组患者血清白蛋白和前白蛋白水平均显著高于同期对照组(均P<0.05);观察组患者低蛋白血症、感染性并发症和不良反应发生率均显著低于对照组(均P<0.05)。治疗28 d后,观察组患者TSF显著大于本组治疗前(P<0.05),对照组患者TSF和MAMC均显著小于本组治疗前(均P<0.05),且观察组患者TSF和MAMC均显著大于同期对照组(均P<0.05),NIHSS评分显著低于对照组(P<0.05),BI评分显著高于对照组(P<0.05)。结论肠内营养序贯治疗能够有效改善重症ACI合并吞咽功能障碍患者的营养状态和预后,减少低蛋白血症、不良反应和感染性并发症的发生。Objective To observe the effect of sequential enteral nutrition on nutritional status and prognosis of patients with severe acute cerebral infarction(ACI)complicated with dysphagia.Method A total of 96 patients with serve ACI complicated with dysphagia treated in China-Japan Friendship Hospital of Jilin University from June 2016 to June 2018 were randomly divided into control group(n=48)and observation group(n=48).Control group patients were treated with routine enteral nutrition therapy and observation group patients were treated with sequential enteral nutrition therapy.After 14 days of treatment,the levels of serum albumin,prealbumin,hemoglobin,and the incidences of hypoproteinemia,infectious complications and adverse reactions were compared between the two groups.After 28 days of treatment,the nutritional status[triceps skinfold thickness(TSF),mid-arm muscle circumference(MAMC)]and prognosis[National Institute of Health stroke scale(NIHSS)score,Barthel index(BI)score]were compared between the two groups.Result After 14 days of treatment,the levels of serum albumin and prealbumin in control group were significantly lower than those before treatment(all P<0.05),the level of prealbumin in observation group was significantly higher than that before treatment(P<0.05),and the levels of serum albumin and prealbumin in observation group were significantly higher than those in control group(all P<0.05).The incidences of hypoproteinemia,infectious complications and adverse reactions in observation group were significantly lower than those in control group(all P<0.05).After 28 days of treatment,the TSF of observation group was significantly larger than that of control group(P<0.05),the TSF and MAMC of control group were significantly less than that of control group(all P<0.05),and the TSF and MAMC of observation group were significantly larger than those of control group(all P<0.05),the NIHSS score was significantly lower than that of control group(P<0.05),the BI score was significantly higher than that of control group

关 键 词：急性脑梗死 重症 营养状态 肠内营养 序贯治疗 

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