早期胃镜下放置鼻肠管在高风险误吸 脑卒中患者中的应用价值

Application value of early enteral nutrition by placing nose intestine tube under gastroscopy in patients with high risk of aspiration stroke

摘要:

目的 探讨早期床旁胃镜下放置鼻肠管肠内营养在高风险误吸脑卒中患者的应用价值。方法 将2012年1月~2013年6月入住该院中心ICU的高风险误吸脑卒中患者随机分为鼻胃管组和鼻肠管组，其中鼻胃管组45例，鼻肠管组41例。鼻胃管组24 h后常规留置鼻胃管予康全力肠内营养，而鼻肠管组24 h后床旁胃镜旁持物钳置管法放置鼻肠管，予康全力肠内营养。比较两组入ICU第1和14天GCS评分、APACHE-II评分、血清清蛋白和转铁蛋白情况，吸入性肺炎发生率及ICU停留时间。结果 入ICU时两组患者在年龄、性别、疾病严重程度和洼田氏饮水实验等一般情况差异无显著性（均P >0.05）。鼻肠管组鼻肠管远端均位于空肠上段，放置成功率为100%。入院第14天，鼻肠管组患者GCS评分高于鼻胃管组，而APACHE-II评分低于鼻胃管组（均P <0.05）。鼻胃管组与鼻肠管组吸入性肺炎发生率分别为31.1%和12.2%，差异有显著性（χ2 =4.460，P =0.035）。入院第14天，鼻肠管组患者血清清蛋白和转铁蛋白均高于鼻胃管组（均P <0.05）。鼻胃管组和鼻肠管组患者ICU停留时间分别为（16.00±4.53）和（13.93±4.83）d（t =2.055，P =0.043）。结论 高风险误吸脑卒中患者早期（24 h）床旁胃镜下放置鼻肠管空肠营养有利于减少吸入性肺炎的发生，改善患者营养状态，缩短ICU停留时间，改善患者预后。值得临床推广。

Abstract:

【Objective】 To investigate application value of the early enteral nutrition by placing nose intestine tube under gastroscopy in high risk of aspiration stroke patients. 【Methods】 86 acute stroke patients with the high risk of aspiration who were admitted to the central ICU of the First Affiliated Hospital of University of South China from January 2012 to June 2013, were randomly divided into two groups: nasogastric tube group and nose intestine tube group. 45 patients of which were in the nasogastric tube group and 41 patients were in the nasal intestine tube group. Enteral nutrition with Enteral Nutritional Suspension (TPF-DM) through nasogastric tube started after 24 h admitted to ICU in the nasogastric tube group, and enteral nutrition with Enteral Nutritional Suspension (TPF-DM) through nose intestine tube placed under gastroscopy started after 24 h admitted to ICU in the nasal intestine tube group. The GCS, APACHE-II score, serum albumin, serum transferrin of the patients in the first day and fourteenth day, aspiration pneumonia (AP) incidence and ICU stay were compared with both groups respectively. 【Results】 The age, sex, severity of illness and the water swallow test classifications had no significant difference in both groups at 24 h admitted to ICU (all P > 0.05). The terminals of nasal intestine tubes were all located in the upper jejunum and had no complications by placing nose intestine tube under gastroscopy. The GCS of patients in the nasal intestine tube group was higher than the nasogastric tube group, but compared with the nasogastric tube group, the APACHE-II scores in the nasal intestine were lower in fourteenth day after admitted to ICU (all P <0.05). Rate of the AP in the nasogastric tube group and in the nasal intestine tube group were 31.1% and 12.2% respectively, (χ2 =4.460,P =0.035). The serum albumin and serum transferrin of the patients in the nasal intestine tube group increased significantly when compared with the nasogastric tube group in fourteenth day after admitted to ICU (all P <0.05). ICU stay were (16.00±4.53) d and (13.93±4.83) d (t =2.055, P =0.043) respectively in the nasogastric tube group and in the nasal intestine tube group. 【Conclusion】 Our data suggest that it helps to reduce the incidence of aspiration pneumonia, improve the nutritional status, shorten ICU stay and improve outcomes of aspiration stroke patients that the early enteral nutrition by placing nose intestine tube under gastroscopy in high risk of aspiration stroke patients after 24 h admission; and it is worthy of promotion in clinical.