一例难治性癫痫患者应用生酮饮食后肠内营养耐受性的评估与管理  

Evaluation and management of enteral nutrition tolerance in a patient with intractable epilepsy after ketogenic diet

作　　者：王宇娇[1] 李虹彦[2] 高岚[1] 戴爽[1] 李文婧 Wang Yujiao;Li Hongyan;Gao Lan;Dai Shuag;Li Wenjing(NCU of the First Hospital of Jilin University,Changchun 130021,China;Department of Nursing,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院神经内科NCU,长春130021 [2]吉林大学第一医院护理部,长春130021

出　　处：《中国实用护理杂志》2020年第14期1097-1101,共5页Chinese Journal of Practical Nursing

基　　金：吉林大学第一医院护理科研基金立项项目(20180204)。

摘　　要：目的总结1例难治性癫痫持续状态患者应用生酮饮食后,早期肠内营养耐受性的评估及管理。方法主要护理要点为实施生酮饮食后每4小时给予个性化肠内营养耐受性评估,包含恶心、呕吐、腹胀、腹泻、胃潴留、上消化道出血;当患者出现生酮饮食胃肠道不耐受时,留置鼻肠管至空肠上段,稀释生酮饮食,增加膳食纤维、胰酶制剂及益生菌的摄入,减少患者腹泻、胃潴留的发生;每4小时监测患者血糖及血酮情况,采用Engel分级评价生酮饮食疗效;早期开展主动活动,促进患者脱机及四肢肌力恢复。结果经过精心的治疗与护理,患者生酮饮食进展顺利,胃肠道不耐受显著改善,入院第30天时,患者Engel分级为Ⅰ级,无影响功能的癫痫发作,病情平稳得到有效控制。入院第66天患者脱机成功,转入普通疗区,住院期间未发生压疮等护理相关并发症,康复出院。结论针对难治性癫痫持续状态行生酮饮食的患者,通过肠内营养耐受性的个性化评估和管理,可以有效降低相关并发症,改善患者预后。Objective To summarize the evaluation and management of early enteral nutrition tolerance in a patient with refractory status epilepticus after ketogenic diet.Methods Nursing essentials were as follows:Individualized enteral nutrition tolerance assessment was given every 4 hours after ketogenic diet,including nausea,vomiting,abdominal distention,diarrhea,gastric retention and upper gastrointestinal bleeding;when patients suffered from intolerance to ketogenic diet,nasointestinal tube was retained to upper jejunum,ketogenic diet was diluted,dietary fiber and trypsin were increased.Intake of preparations and probiotics could reduce the incidence of diarrhea and gastric retention.Blood sugar and ketone levels were monitored every 4 hours to evaluate the therapeutic effect of ketogenic diet by Engel grading.Early active mobility was carried out to reduce the mechanical ventilation time and improve limb muscle strength.Results After careful treatment and nursing,ketogenic diet progressed smoothly and gastrointestinal intolerance improved significantly.On the 30th day of admission,Engel was grade I.The patient was stable with no functional epileptic attack.On the 66th day after admission,the patient was successfully taken off line and transferred to the general treatment area.During the period of hospitalization,there was no nursing related complications such as pressure ulcer,and the patient recovered and discharged.Conclusion Individualized assessment and management of enteral nutrition tolerance can effectively reduce the related complications and improve the prognosis of patients with refractory status epilepticus who take ketogenic diet.

关 键 词：护理 难治性癫痫持续状态 生酮饮食 肠内营养耐受性 

分 类 号：R473[医药卫生—护理学]