经皮内镜下胃空肠造瘘术置管行肠内营养治疗重症脑出血患者的应用价值分析  

Efficacy of enteral nutrition through percutaneous endoscopic gastrostomy/jejunostomy in patients with severe cerebral hemorrhage

作　　者：黄从刚[1] 张严国[1] 罗明[1] 宋平[1] 王兴弯 罗志华[1] 张勤 周洁 王俊 段发亮[1] Huang Conggang;Zhang Yanguo;Luo Ming;Song Ping;Wang Xingwan;Luo Zhihua;Zhang Qin;Zhou Jie;Wang Jun;Duan Faliang(Department of Neurosurgery,First Hospital of Wiuhan,Wuhan 430022,China;Department of Interventional Radiology,First Hospital of Wuhan,Wuhan 430022,China)

机构地区：[1]武汉市第一医院神经外科,430022 [2]武汉市第一医院神经介入科,430022

出　　处：《中华神经医学杂志》2020年第8期810-815,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨经皮内镜下胃空肠造瘘术置管行肠内营养治疗重症脑出血患者的应用价值。方法选择武汉市第一医院神经外科自2015年1月至2018年12月行肠内营养治疗的85例重症脑出血患者,根据肠内营养治疗方式的不同分为鼻胃管组(44例)和经皮内镜下胃空肠造瘘术置管组(41例)。回顾性分析患者的临床资料,比较2组患者的肠内营养治疗效果及并发症发生率、住院时间的差异。结果与鼻胃管组比较,经皮内镜下胃空肠造瘘术置管组患者的腹泻、胃潴留、低蛋白血症的发生率较低.管道堵塞率较高,差异有统计学意义(P<0.05)。经皮内镜下胃空肠造瘘术置管组患者的住院时间(35.2±4.7)d低于鼻胃管组患者的住院时间[(37.6±5.4)d],差异有统计学意义(P<0.05)。鼻胃管组、经皮内镜下胃空肠造瘘术置管组患者肠内营养治疗后NRS2002评分分别为(1.73±0.52)分.(1.87±0.64)分。差异无统计学意义(P<0.05)。结论对重症脑出血患者采用经皮内镜下胃空肠造瘘术置管行肠内营养治疗,可降低腹泻、胃潴留、低蛋白血症等并发症的发生率,缩短住院时间,但应注意降低胃空肠造瘘术置管的堵管率。Objective To investigate the therapeutic efficacy of enteral nutrition through percutaneous endoscopic gastrostomy/jejunostomy(PEG/PEJ)in patients with severe cerebral hemorrhage.Methods Eighty-five patients with severe cerebral hemorrhage admitted to our hospital from January 2015 to December 2018 were enrolled into this retrospective study.According to ways of enteral nutrition,all 85 patients were divided into nasogastrie tube group(n=44)and PEG/PEJ tube group(n=41).The clinical data were analyzed retrospectively,and the enteral nutrition treatment efficacy,incidence of complications,and length of hospital stays between the two groups were compared.Results The incidences of diarrhea(14.6%,6/41),gastric retention(34.1%,14/41),and hypoproteinemia(26.8%,11/41)in PEG/PEJ tube group were significantly lower than those in nasogastric tube group(38.6%[17/44],59.1%[26/44],and 47.7%[21/44],P<0.05).However,the rate of obstruction ducts in PEG/PEJ tube group(34.1%,14/41)was significantly higher than that in nasogastric tube group(11.4%,5/44,P<0.05).As compared with the patients in nasogastric tube group,patients in the PEG/PEJ tube group had signifieantly shorter average length of hoopital stays([35.2±4.7]d vs.[37.6±5.4]d,P<0.05).The NRS2002 scores of patients in the nasogstric tube group and PEG/PEJ tube group after enteral nutrition treatment were 1.73±0.52 and 1.87±0.64,respectively,without significant difference(P<0.05).Conclusion The enteral nutrition treatment through PEG/PEJ could significantly reduce the incidences of diarrhea,gastric retention and hypoproteinemia,and shorten the average length of hospital stays in patients with severe cerebral hemorrhage;rate of obstruction of percutaneous endoscopic jejunostomy ducts should be reduced.

关 键 词：重症脑出血 肠内营养 经皮内镜下胃空肠造瘘术置管 鼻胃管 并发症 

分 类 号：R651.1[医药卫生—外科学]