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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2017, Vol. 10 ›› Issue (04) : 230 -234. doi: 10.3877/cma.j.issn.1674-6880.2017.04.004

所属专题： 文献；

营养与代谢

鼻胃管减压联合鼻肠管营养支持对重症神经系统疾病患者预后的影响
潘小东1, 张京臣2, 汤鲁明1, 孙来芳1,†()   
  1. 1. 325027　浙江温州，温州医科大学附属第二医院急诊科
    2. 310003　杭州，浙江大学医学院附属第一医院急诊科
  • 收稿日期:2017-04-30 出版日期:2017-08-01
  • 通信作者: 孙来芳
  • 基金资助:
    浙江省温州市科技计划项目(Y20140077)

Effect of nasogastric tube decompression combined with nasointestinal tube nutritional support in the prognosis of patients with severe nervous system diseases

Xiaodong Pan1, Jingchen Zhang2, Luming Tang1, Laifang Sun1,†()   

  1. 1. Department of Emergency Medicine, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
    2. Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
  • Received:2017-04-30 Published:2017-08-01
  • Corresponding author: Laifang Sun
  • About author:
    Corresponding author: Sun Laifang, Eamil: sunlaifang@163.com
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潘小东, 张京臣, 汤鲁明, 孙来芳. 鼻胃管减压联合鼻肠管营养支持对重症神经系统疾病患者预后的影响[J/OL]. 中华危重症医学杂志(电子版), 2017, 10(04): 230-234.

Xiaodong Pan, Jingchen Zhang, Luming Tang, Laifang Sun. Effect of nasogastric tube decompression combined with nasointestinal tube nutritional support in the prognosis of patients with severe nervous system diseases[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(04): 230-234.

目的

评估胃管减压联合鼻肠管营养支持对重症神经系统疾病患者预后的影响。

方法

将90例患者分为鼻肠管组和鼻胃管组，每组各45例。收集两组患者入组时急性病生理学和长期健康评价（APACHE）Ⅱ评分及格拉斯哥昏迷评分（GCS）；收集每例患者治疗后1、7、14 d白蛋白水平及肠内营养热卡；记录并比较各组患者并发症的发生情况及机械通气时间、ICU住院时间、总住院时间、病死率情况。

结果

鼻肠管组及鼻胃管组患者APACHEⅡ评分[（20.5 ± 6.4）分vs.（20.3 ± 6.9）分]、GCS评分[（6.1 ± 1.3）分vs.（5.5 ± 1.5）分]间比较，差异均无统计学意义（t = 0.140、0.270，P = 0.888、0.787）。鼻肠管组患者治疗后14 d的血白蛋白水平[（37.5 ± 2.8）g/L vs.（34.2 ± 5.6）g/L]及获得肠内营养热卡[（2 147 ± 625）kcal vs.（1 791 ± 768）kcal]较鼻胃管组显著升高（t = 3.548、2.412，P = 0.001、0.017）。同时，鼻肠管组患者吸入性肺炎（5/45 vs. 20/45）、营养液潴留（3/45 vs. 19/45）的发生率显著低于鼻胃管组患者（χ2 = 12.462、15.401，P = 0.001、0.001）。而两组患者在机械通气时间（t = 1.149，P = 0.253）、ICU住院时间（t = 0.763，P = 0.447）、总住院时间（t = 1.251，P = 0.214）及病死率（χ2 = 0.403，P = 0.525）的比较，差异均无统计学意义。

结论

对于重症神经系统患者早期进行胃管减压联合鼻空肠管营养更能有效改善其营养状况、减少并发症的发生，对改善患者预后有一定的临床价值。

关键词: 营养支持, 肠道营养, 神经系统疾病, 预后
Objective

To evaluate the effect of nasogastric tube decompression combined with nasointestinal tube nutritional support in the prognosis of patients with severe nervous system diseases.

Methods

A total of 90 patients with severe nervous system diseases were divided into the nasointestinal tube group (n = 45) and the nasogastric tube group (n = 45). The acute physiology and chronic health evaluation (APACHE) Ⅱ and Glasgow coma scale (GCS) were calculated after the patients were recruited into the groups. The levels of albumin and calories gained from enteral nutrition were determined on 1, 7, 14 d after treatment. The incidence of complications, duration of mechanical ventilation, length of ICU stay, total length of hospital stay and mortality rate were also recorded and compared between these two groups.

Results

The APACHE Ⅱ scores [(20.5 ± 6.4) vs. (20.3 ± 6.9)] and GCS scores [(6.1 ± 1.3) vs. (5.5 ± 1.5)] all showed no significant differences in the nasointestinal tube group and the nasogastric tube group (t = 0.140, 0.270; P = 0.888, 0.787). The levels of albumin [(37.5 ± 2.8) g/L vs. (34.2 ± 5.6) g/L] and calories gained from enteral nutrition [(2 147 ± 625) kcal vs. (1 791 ± 768) kcal] on 14 d after treatment in the nasointestinal tube group were both much higher than those in the nasogastric tube group (t = 3.548, 2.412; P = 0.001, 0.017). Meanwhile, the incidence of aspiration pneumonia (5/45 vs. 20/45) and nutrient fluid retention (3/45 vs. 19/45) in the nasointestinal tube group were much lower than those in the nasogastric tube group (χ2 = 12.462, 15.401; P = 0.001, 0.001). However, there were no significant differences in the duration of mechanical ventilation (t = 1.149, P = 0.253), length of ICU stay (t = 0.763, P = 0.447), total length of hospital stay (t = 1.251, P = 0.214) and mortality rate (χ2 = 0.403, P = 0.525) between the two groups.

Conclusion

Nasogastric tube decompression combined with nasointestinal tube nutritional support at the early stage can improve nutritional status and reduce complications in patients with severe nervous system diseases.

Key words: Nutritional support, Enteral nutrition, Nervous system diseases, Prognosis
表1 两组重症神经系统疾病患者临床指标的比较（ ± s）
组别 例数 白蛋白（g/L） 肠内营养热卡（kcal）
1 d 7 d 14 d 1 d 7 d 14 d
鼻肠管组 45 29.6 ± 5.6 30.7 ± 5.3 37.5 ± 2.8 570 ± 134 1 335 ± 523 2 147 ± 625
鼻胃管组 45 31.5 ± 6.1 29.8 ± 3.7 34.2 ± 5.6 574 ± 180 1 339 ± 443 1 791 ± 768
t值 ? 1.539 0.934 3.548 0.119 0.039 2.412
P值 ? 0.127 0.352 0.001 0.905 0.968 0.017
表2 两组重症神经系统疾病患者并发症及相关终点指标的比较（ ± s）
组别 例数 吸入性肺炎（例） 消化道出血（例） 腹泻（例） 营养液潴留（例） 机械通气时间（d） ICU住院时间（d） 总住院时间（d） 病死率[（例）%]
鼻肠管组 45 5 11 11 3 10 ± 5 18.2 ± 3.8 36 ± 20 19（42.22）
鼻胃管组 45 20 15 14 19 11 ± 5 18.7 ± 2.2 32 ± 11 22（48.89）
t/χ2值 ? 12.462 0.865 0.498 15.401 1.149 0.763 1.251 0.403
P值 ? 0.001 0.352 0.480 0.001 0.253 0.447 0.214 0.525
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