经鼻空肠管早期肠内营养对高误吸风险的重症脑血管病老年患者的应用价值  

Application value of early jejunal intubation for enteral nutrition in elderly patients with severe cerebrovascular disease with high risk of aspiration

作　　者：史颖[1] 金鑫[1] 冯鑫利[2] 袁蓓[1] 安莉[1] 王惠凌[1] 王乾 钱琳琳 SHI Ying;JIN Xin;FENG Xin-li;YUAN Pei;AN Li;WANG Hui-ling;WANG Qian;QIAN Lin-lin(Department of Neurology, the Affiliated Hospital of Hebei University, Baoding 071000, China;Department of Hyperbaric Oxygen, the Affiliated Hospital of Hebei University, Baoding 071000, China)

机构地区：[1]河北大学附属医院神经内科,071000 [2]河北大学附属医院高压氧科,071000

出　　处：《现代消化及介入诊疗》2020年第5期585-589,594,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：河北省重点研发计划(172777160);河北省医学科学研究课题计划(20190923);保定市科技计划项目(17ZF224);河北大学附属医院基金项目(2017Q031)。

摘　　要：目的探讨经鼻空肠管早期肠内营养对合并高误吸风险的重症脑血管病老年患者的应用价值。方法选取2016年12月至2018年12月河北大学附属医院收治发病48 h内合并高误吸风险的重症脑血管病老年患者62例,随机分为鼻胃管组(对照组)31例,鼻空肠管组(观察组)31例。鼻空肠管组患者首先进行床旁徒手置入,对于床旁徒手置入困难者继续行胃镜辅助下鼻空肠管置入。比较两组患者营养状态指标[包括血清白蛋白(ALB)、血清前白蛋白(PA)、血红蛋白(HGB)、外周血淋巴细胞计数(TLC)]、胃肠道并发症(包括呕吐、反流、腹胀、腹泻、应激性溃疡)发生率、5 d内肠内营养达标率、医院获得性肺炎(HAP)发生率、炎症指标[包括血白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)]、神内重症(NICU)花费及病死率。结果床旁徒手置入鼻空肠管成功率为90.3%,总置管成功率100%。鼻空肠管组治疗后营养状态指标、炎症指标无明显变化;鼻胃管组治疗后营养状态指标均有所下降,炎症指标均较治疗前增高。鼻空肠组治疗后营养状态优于鼻胃管组,炎症指标较低,HAP发生率较低,NICU费用较低,同时鼻空肠管组胃肠道并发症包括呕吐、反流发生率降低,5 d内营养达标率较高,病死率较低。结论有针对性的对存在高误吸风险的重症脑血管病老年患者经鼻空肠管早期肠内营养有助于营养状态的维持,改善肠内营养耐受性,降低医院获得性肺炎(HAP)发生率,减少NICU费用,改善患者预后。Objective To explore the value of early jejunal intubation for enteral nutrition in elderly patients with severe cerebrovascular disease with high risk of aspiration.Methods 62 elderly patients with severe cerebrovascular disease with high risk of aspiration who were admitted to NICU within 48 hours from December 2016 to December 2018 were collected.The patients were randomly divided into nasogastric tube group(control group)and nasojejunal tube group(observation group).Each group consisted of 31 patients.The nasojejunal tube group first underwent bedside bare-handed insertion.For those who had difficulty in bare-handed insertion,nasojejunal tube insertion was continued under gastroscopy.Comparing the two groups of patients with nutritional status indicators(including ALB,PA,HGB,TLC),incidence of gastrointestinal complications(including vomiting,reflux,abdominal distention,diarrhea,stress ulcer),numbers of nutrition target values achieved within 5 days,incidence of hospital-acquired pneumonia(HAP),inflammatory indicators(including WBC,CRP,PCT),NICU cost and mortality.Results The success rate of bedside bare-handed nasojejunal tube insertion was 90.3%and the total success rate of jejunal intubation was 100%.There was no significant change in nutritional status and inflammatory index in nasogastric tube group.However,in the nasogastric tube group,the nutritional status index decreased and the inflammatory index increased after treatment.The nutritional status of nasojejunal tube group was better,the inflammation index,the incidence of HAP and the cost of NICU in the nasojejunal tube group were lower than those in control group after treatment.Meanwhile,the incidence of gastrointestinal complications including vomiting,reflux in nasojejunal tube group were lower than those in control group,and the rate of nutrition reaching the standard was higher.At the same time,the mortality rate of patients decreased significantly.Conclusion For elderly patients with severe cerebrovascular disease at early stage with high risk o

关 键 词：鼻空肠管 肠内营养 吸入性肺炎 医院获得性肺炎 重症脑血管病 

分 类 号：R573[医药卫生—消化系统] R563[医药卫生—内科学]