经管饲补水对神经外科重症患者早期肠内营养喂养达标率及血糖变异性的影响  

The impact of fluid therapy through enteral feeding tube on energy target achievement and glycemic variability in neurosurgical critically ill patients

作　　者：江一帆 施雁[1] 王婧怡 孔晓倩 王莉 费凯红 张亚娟 马蓉[4] 邱瑾[5] Jiang Yifan;Shi Yan;Wang Jingyi;Kong Xiaoqian;Wang Li;Fei Kaihong;Zhang Yajuan;Ma Rong;Qiu Jin(School of Medicine,Tongji University,Shanghai 200092,China)

机构地区：[1]同济大学医学院,上海200092 [2]上海交通大学医学院附属第一人民医院护理部 [3]上海交通大学医学院附属第六人民医院护理部 [4]上海交通大学医学院附属仁济医院护理部 [5]上海交通大学医学院附属新华医院护理部

出　　处：《护理学杂志》2025年第8期7-10,共4页Journal of Nursing Science

基　　金：国家自然科学基金面上项目(72274136);上海交通大学医学院护理学科建设项目(SJTUHLXK2023)。

摘　　要：目的探讨经管饲补水对神经外科重症患者早期肠内营养喂养达标率及血糖变异性的影响。方法采用多中心前瞻性队列研究,纳入2023年1-12月上海市4所三甲医院重症监护室的136例神经外科重症患者,根据患者是否经肠内营养管补水分为对照组(纯肠内营养,未通过鼻饲管补水)与暴露组(肠内营养前经鼻饲管补水500 mL)各68例。比较两组患者肠内营养前3 d的喂养达标率、血糖变异性、胃肠道耐受性及肠内营养输注时间的差异。结果最终对照组65例、暴露组61例完成研究。暴露组的喂养达标率显著低于对照组,血糖变异性显著高于对照组,实际肠内营养输注时间显著短于对照组(均P<0.05)。两组胃肠道耐受性评分比较,差异无统计学意义(P>0.05)。结论早期肠内营养期间经管饲补水可影响神经外科重症患者肠内营养喂养达标率及血糖变异性,应谨慎使用。Objective To explore the impact of fluid therapy through enteral feeding tube on energy target achievement and glycemic variability(GV)in neurosurgical critically ill patients during early enteral nutrition(EN).Methods A multicenter prospective cohort study was conducted in four tertiary hospitals in Shanghai from January to December 2023.A total of 136 neurosurgical critically ill patients were divided into two groups of 68,the control group who only received EN and the exposure group who received 500 mL of fluid through feeding tube before routine EN.The differences in energy target achievement within 3 days of initiating EN,GV,gastrointestinal tolerance,and EN time were compared between the two groups.Results A total of 65 patients in the control group and 61 in the exposure group completed the study.The exposure group had significantly lower energy target achievement rate,higher GV,and shorter EN time compared to the control group(all P<0.05).There was no significant difference in gastrointestinal tolerance between the two groups(P>0.05).Conclusion Fluid therapy given through enteral feeding tube may impact energy target achievement rate and GV in neurosurgical critically ill patients during early EN,so it is not recommended.

关 键 词：神经外科 ICU 肠内营养 营养治疗 管饲 喂养达标 血糖 护理 

分 类 号：R472[医药卫生—护理学] R459.3[医药卫生—临床医学]