颈椎脊髓损伤机械通气患者鼻肠管肠内营养的疗效观察  

Effect of postpyloric enteral nutrition in patients with cervical spinal cord injury undergoing mechanical ventilation

作　　者：周健 周秋香 闫月月 瞿金龙 Zhou Jian;Zhou Qiuxiang;Yan Yueyue;Qu Jinlong(Department of Emergency and Critical Care,Second Affiliated Hospital of PLA Naval Medical University,Shanghai 200003,China)

机构地区：[1]中国人民解放军海军军医大学第二附属医院急诊重症医学科,上海200003

出　　处：《肿瘤代谢与营养电子杂志》2022年第2期207-211,共5页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：上海市科学技术委员会科研计划项目(19140902800)。

摘　　要：目的 探讨颈椎脊髓损伤机械通气(MV)患者留置鼻肠管进行幽门后肠内营养(EN)的疗效。方法 选择2018年9月至2020年9月中国人民解放军海军军医大学第二附属医院急诊重症医学科(ICU)收治的70例围手术期进行MV治疗的颈椎脊髓损伤患者,通过随机数字表法分经鼻肠管饲养EN组(研究组)和经鼻胃管饲养EN组(对照组),其中4例退出,最终将研究组35例和对照组31例纳入研究。分别于治疗前和治疗后3 d、7 d以及出院前观察并比较尿素氮(BUN)、血红蛋白(HB)、血清白蛋白(ALB)和前白蛋白(PA)的水平,MV时间和ICU住院时间,以及反流、腹胀等并发症的发生率。结果 研究组在出院前PA水平明显高于对照组[(339.2±105.7)mg/L比(286.5±86.5)mg/L](P<0.05),其余营养指标差异均无统计学意义(P>0.05)。研究组较对照组MV时间缩短[3.0(2.0,8.0)d比6.0(3.0,11.0)d],腹胀发生率降低[14.3%(5/35)比35.5%(11/31)],住院时间缩短[9.0(8.0,12.0)d比12.0(9.0,15.5)d],差异均有统计学意义(P<0.05)。结论 颈椎脊髓损伤患者采用鼻肠管进行EN治疗可改善患者营养情况,缩短MV时间和住院时间,减少胃肠并发症发生率。Objective To explore the effect of postpyloric enteral nutrition(EN) in patients with cervical spinal cord injury undergoing mechanical ventilation(MV). Method 70 patients with cervical spinal cord injury who were treated with MV in intensive care unit(ICU)of Second Affiliated Hospital of PLA Naval Medical University from September 2018 to September 2020 were randomly divided into two groups, nasointestinal tube group and nasogastric tube group. Among them, 4 cases in the control group withdrew from the experiment for some reason and the final two groups with 35 and 31 cases respectively. Blood urea nitrogen(BUN), hemoglobin(HB), serum albumin(ALB), prealbumin(PA) before treatment, 3 days, 7 days after treatment and before discharge, duration of MV, ICU hospitalization time and the incidence of reflux and abdominal distension were observed and compared. Result The PA level in nasointestinal tube group was significantly higher than that in nasogastric tube group before discharge [(339.2±105.7) mg/L vs(286.5 ± 86.5) mg/L](P<0.05), the other nutritional indexes had no significant difference(P>0.05). Compared with nasogastric tube group, patients in nasointestinal tube group had shorter ventilator support time [3.0(2.0,8.0) d vs 6.0(3.0,11.0) d], lower incidence of abdominal distension[14.3%(5/35) vs 35.5%(11/31)], lower hospitalization time[9.0(8.0,12.0) d vs 12.0(9.0,15.5) d], and the differences were significant(P<0.05). Conclusion EN with nasointestinal tube can improve the nutritional status of patients with cervical spinal cord injury, shorten the duration of MV and ICU hospitalization time, and reduce the incidence of gastrointestinal complications.

关 键 词：颈椎脊髓损伤 机械通气 鼻肠管留置 肠内营养 

分 类 号：R651.2[医药卫生—外科学] R459.3[医药卫生—临床医学]