改良胃管置入法在脑卒中静脉溶栓患者中的应用及效果分析  

Clinical application and effect of modified gastric tube implantation for the acute ischemic stroke patients with intravenous thrombolysis

作　　者：唐娜[1] 何婧瑜[1] 徐佳丽 王晶[1] 张春燕[1] 王朝辉 梁潇[1] 李思颉[1] TANG Na;HE Jingyu;XU Jiali;WANG Jing;ZHANG Chunyan;WANG Zhaohui;LIANG Xiao;LI Sijie(Department of Emergency Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院急诊科,北京100053

出　　处：《中国急救复苏与灾害医学杂志》2022年第8期1088-1091,1096,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：国家自然科学基金青年科学基金项目(编号:81801313)。

摘　　要：目的探讨改良胃管留置方法在脑卒中静脉溶栓患者中应用的安全性和有效性,并与常规胃管留置方法进行比较。方法将2019年4月—2021年4月收治于首者医科大学宣武医院急诊观察病房的157例脑卒中静脉溶栓患者随机分为试验组(n=73)和对照组(n=84)。对照组使用常规胃管留置方法,试验组使用改良版胃管留置方法,探讨改良胃管留置方法的安全性,并比较1个月随访时两组患者相关临床并发症的发生率。结果①试验组患者置入胃管后粘膜出血、非计划拔管发生率明显低于对照组(试验组vs对照组:9.5%vs 27.8%;17.5%vs 33.7%),差异存在统计学差异(P<0.05);且显著降低了患者卒中后肺炎的比例(36.5%vs 55.4%,P<0.05)。②试验组患者出院营养评分[(2.64±1.46)vs(2.18±1.20),P<0.05]及Branden评分[(13.07±1.89)vs(12.39±1.57),P<0.05)]显著高于对照。③Logistic回归分析发现,胃管置入的方法不同是患者粘膜出血的重要影响因素(OR=3.494,95%CI=1.380~8.840,P=0.008)。结论改良胃管留置方法通过提高患者的舒适度和耐受性,降低患者住院期间的粘膜出血和非计划拔管的几率,并降低患者脑卒中后肺炎的发生率。Objective To explore the safety and efficacy of the modified gastric tube placement in patients with acute ischemic stroke(AIS).Methods 157 AIS patients were randomly divided into 2 group:control group(n=84)undergoing conventional gastric tube indwelling method and experimental group(n=73)undergoing modified gastric tube implantation.The safety of the modified gastric tube indwelling method was discussed,and the incidence of related clinical complications between the two groups during one month follow-up was compared.Results①The incidence rate of mucosal and gastrointestinal bleeding,pneumonia in hospital,and unplanned extubation after gastric tube placement of the experimental group were 9.5%,36.5%,and 17.5%respectively,all significantly lower than those of the control group(27.8%,55.4%,and 33.7%respectively,all P<0.05).②the hospital nutrition scores and Branden score of the experimental group were(2.64±1.46)and(13.07±1.89)respectively,both significantly higher than those of the control group[(2.18±1.20)and(12.39±1.57)respectively,both P<0.05].③Logistic regression analysis found that gastric tube indwelling method was significantly correlated with mucosal hemorrhage(OR=3.494,95%CI,1.380~8.840,P=0.008).Conclusion The modified way of gastric tube placement may improve the comfort and tolerance of the patient,reduce the incidence of mucosal hemorrhage and unexpected extraction in the patient during hospitalization,and may reduce the incidence of pneumonia in patients after stroke.

关 键 词：急性脑卒中 静脉溶栓 吞咽障碍 改良胃管置入法 肺炎 

分 类 号：R473[医药卫生—护理学]