早期鼻饲肠内营养支持联合高压氧治疗重症卒中患者  

Effect of early enteral nutrition support by nasal feeding combined with hyperbaric oxygen in patients with severe stroke

作　　者：冯鑫利[1] 金鑫[2] 陈向红[3] 董爽[1] 杨洁[1] 蔡少华 彭广军[4] 张大辉[4] FENG Xinli;JIN Xin;CHEN Xianghong;DONG Shuang;YANG Jie;CAI Shaohua;PENG Guangjun;ZHANG Dahui(Hyperbaric Oxygen Therapy Room,Affiliated Hospital of Hebei University,Baoding 071000,China;Department of Neurology,Affiliated Hospital of Hebei University,Baoding 071000,China;Department of Otorhinolaryngology,Affiliated Hospital of Hebei University,Baoding 071000,China;Department of Emergency Medicine,Affiliated Hospital of Hebei University,Baoding 071000,China)

机构地区：[1]河北大学附属医院高压氧治疗室,河北保定071000 [2]河北大学附属医院神经内科,河北保定071000 [3]河北大学附属医院耳鼻喉科,河北保定071000 [4]河北大学附属医院急诊医学科,河北保定071000

出　　处：《内科理论与实践》2020年第6期414-419,共6页Journal of Internal Medicine Concepts & Practice

基　　金：河北省2019年度医学科学研究课题计划(项目编号:20190923)。

摘　　要：目的 :观察早期鼻饲肠内营养(enteral nutritional,EN)支持联合高压氧(hyperbaric oxygen,HBO)治疗重症卒中患者的临床疗效。方法:纳入2016年1月至2019年6月间来我院就诊的116例明确诊断为重症卒中患者,其中发病24 h内即进行鼻饲EN支持者37例(EN组),在体征平稳后行HBO治疗并进行鼻饲常规流食者39例(HBO组),在体征平稳后行HBO治疗并在发病24 h内行鼻饲EN支持者40例(联合组)。对比分析3组治疗前后的各营养指标[白蛋白(albumin,ALB)、总蛋白(total protein,TP)和前白蛋白(prealbumin,PA)]、各炎症指标[白细胞(white blood cell,WBC)、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)]、胃肠道并发症发生率及其他住院指标[神经内科重症监护病房(intensive care unit,ICU)停留时间、医院获得性肺炎(hospital acquired pneumonia,HAP)发生率、4周内死亡率]等以确定最佳治疗方法。结果:治疗前3组间各营养指标、各炎症指标、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分比较差异无统计学意义(均P>0.05)。治疗10 d后3组各营养指标、炎性指标均低于治疗前(均P<0.05),联合组各营养指标依次高于EN组、HBO组,而联合组各炎性指标依次低于HBO组、EN组(均P<0.05)。治疗2周后3组NIHSS评分均低于治疗前(均P<0.05),且联合组依次低于EN组、HBO组(均P<0.05)。治疗10 d内联合组腹泻发生率低于HBO组和EN组(P<0.05)。治疗4周内联合组神经内科ICU停留时间依次低于HBO组、EN组(均P<0.05),HAP发生率和4周累计死亡率3组差异无统计学意义(均P>0.05)。结论:早期鼻饲EN支持联合HBO应用于治疗重症卒中患者具有较好的临床效果,值得临床推荐。Objective To observe the clinical effect of early enteral nutrition(EN) support by nasal feeding combined with hyperbaric oxygen(HBO) in patients with severe stroke. Methods A total of 116 patients diagnosed as severe stroke in our hospital from January 2016 to June 2019 were selected as the research subjects. Among them, 37 patients received nasal feeding and EN support within 24 h of stroke onset(EN group), 39 patients received HBO therapy and nasal feeding conventional liquid food(HBO group) after conditions stabilized, and 40 patients received nasal feeding within 24 h of on-set and got HBO therapy after conditions stabilized(combination group). The nutrition indicators [albumin(ALB), total pro-tein(TP) and prealbumin(PA)], inflammation indicators [white blood cell(WBC), C-reactive protein(CRP), procalcitonin(PCT)], the incidence of gastrointestinal complications and other hospitalization indicators [neuro-intensive care unit(NICU) stay time, hospital-acquired pneumonia(HAP) incidence, mortality] in three groups were compared and analyzed to determine the best treatment. Results Before treatment, there were no significant differences in the nutritional indicators,inflammation indicators, and neurological deficits evaluated with National Institute of Health stroke scale(NIHSS) scores a-mong the three groups(all P>0.05). After 10-day treatment, the nutritional indicators and inflammatory indexes of the three groups were significantly lower than those before treatment(all P<0.05). The nutritional indicators of the combined group were higher than those of the EN group and the HBO group, while the inflammatory indexes of the combined group were lower than those of the HBO group and the EN group(all P<0.05). After 2-week treatment, the NIHSS scores of the three groups were lower than the scores before treatment(all P<0.05), and the NIHSS scores of the combination group were lower than those of the EN group and the HBO group(P<0.05). During 10-day treatment, the incidence of diarrhea in the combined group were lower

关 键 词：鼻饲肠管法 早期肠内营养支持 高压氧治疗 重症卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]