论文部分内容阅读
目的:探讨早期肠内营养支持对重症脑血管病患者营养指标及短期预后的影响。方法:选择2017年5月至2018年12月入住包头市中心医院神经内科重症监护病房并需要长期管饲喂养的患者。将患者随机分为早期(发病3天内)喂养组(E组)和常规(发病7天内)喂养组(L组)，收集两组4周内血清前白蛋白、白蛋白、血红蛋白、上臂肌围、皮褶厚度及美国国立卫生研究院卒中量表(NIHSS)评分等指标。统计两组感染率、胃肠道并发症发生率。结果:E组血清白蛋白在第3周时高于L组，差异具有统计学意义(n P＝0.025)；E组血清前白蛋白在第2周时高于L组，比较差异有统计学意义(n P＝0.003)；两组血红蛋白浓度比较差异无统计学意义(n P>0.05)，但同组4周末血红蛋白浓度与入院时比较差异具有统计学意义(n P＝0.0005)。两组患者皮褶厚度和上臂肌围比较差异无统计学意义(n P>0.05)。E组NIHSS评分在第2周时低于L组，差异有统计学意义(n P＝0.03)；两组Barthel指数评分比较差异有统计学意义(n P>0.05)。两组患者肺感染及泌尿系感染发生率比较，差异无统计学意义(n P>0.05)。E组腹泻率高于L组，差异有统计学意义(n P＝0.033)。n 结论:对于重症脑血管患者，早期给予肠内营养支持，具有安全性与有效性，可改善神经功能障碍。早期连续肠内营养支持可以促进血清白蛋白、前白蛋白恢复正常，保持肌肉及脂肪容积相对稳定。“,”Objective:To investigate the impact of early enteral nutrition (EN) on nutritional indicators and short-term prognosis of patients with severe cerebrovascular disease.Methods:Patients receiving EN from May 2017 to December 2018 in our department were enrolled and randomized into early (within 3 days after onset) feeding group (group E) and conventional (within 7 days after onset) feeding group (group L). Albumin, prealbumin, hemoglobin, upper arm muscle circumference (AMC), skin fold thickness (TSF), neurological function score were detected on day 1, 7, 14, 21 and 28. The incidence of infection and gastrointestinal complications were calculated.Results:The serum albumin levels of group E at day 21 were significantly higher than that of group L (n P=0.025). The serum prealbumin levels of group E at day 14 were significantly higher than that of group L (n P=0.003). For hemoglobin levels, no significant difference was observed between two groups (n P>0.05 while the changes from admission to day 28 were significant within either group (n P=0.0005). The difference of TSF and AMC values between two groups was not statistically significant (n P>0.05) at any time point. The national institutes of health stroke scale (NIHSS) scores at day 14 showed significant difference between two groups (n P=0.03) while none in Barthel index (n P>0.05). Concerning clinical complications, diarrhea was more commonly observed in group E than group L (n P=0.033) while incidence of pneumonia and urinary tract infection was comparable between groups.n Conclusions:Early EN is safe and effective for patients with severe cerebrovascular disease, and can maintain nutritional indicator levels stable, such as serum albumin, serum prealbumin, and muscle and adipose tissue volume. Patients receiving early EN displayed improved neurological dysfunction but remained disabled.