早期肠内营养及护理支持对危重症脑血管疾病并发症的治疗作用
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摘要
目的:探讨神经内科重症患者肠内营养时机与并发症的分析及护理对策.方法:随机选取我院2011-10/2013-09收治的行肠内营养支持治疗的重症患者120例,随机平均分为两组,分别为试验组和对照组各60例.试验组患者给予早期肠内营养治疗的方法,并给予相应的护理对策,对照组采用常规营养治疗法治疗,观察并记录两组患者的各项生化指标、死亡例数、发生并发症例数、发生后遗症例数等,然后再进行统计学处理.结果:试验组患者有效治疗54例,有效率为90%,对照组有效治疗21例,有效率为35%,可以得出试验组治愈效果明显高于对照组,差异具有统计学意义(P<0.05);两组患者饮食量、排便量、呕吐及腹泻等一般情况均无明显差异(P>0.05);两组生理指标血压、心率等无明显差异(P>0.05);两组在Na+、Ca2+和血清白蛋白含量方面也没有明显差异(P>0.05);试验组死亡1例,对照组死亡7例;试验组发生并发症4例,对照组发生并发症12例;试验组发生后遗症3例,对照组发生后遗症10例.结论:在相应护理条件下,对重症患者给予早期肠内营养治疗,可有效降低并发症的发生概率,加快促进患者术后肠胃肠功能恢复,值得临床推广应用.
AIM: To investigate enteral nutrition timing and nursing strategy in patients with severe cerebrovascular diseases to prevent the occurrence of complications.METHODS: One hundred and twenty patients with severe cerebrovascular diseases who underwent enteral nutrition support therapy at our hospital from October 2011 to September 2013 were included and randomly divided into two groups: an experimental group and a control group, with 60 patients in each group. The experimental group received early enteral nutrition therapy and appropriate care measures, while the control group underwent conventional nutritional treatment. Biochemical indicatorsand the numbers of deaths, complications and sequelae were recorded and compared between the two groups. RESULTS: The effective rate was significantly higher in the experimental group than in the control group(90% vs 35%, P < 0.05). There were no significant differences in food intake, defecation, vomiting and diarrhea, physiological blood pressure, heart rate, Na+, Ca2+ or serum albumin levels between the two groups(P > 0.05 for all). There was one death in the experimental group and seven deaths in the control group. The number of complications was 4 in the experimental group and 12 in the control group. The number of sequelae was 3 in the experimental group and 10 in the control group. CONCLUSION: Appropriate care and early enteral nutrition in critically ill patients can effectively reduce the occurrence of complications and accelerate the recovery of gastrointestinal function.
AIM: To investigate enteral nutrition timing and nursing strategy in patients with severe cerebrovascular diseases to prevent the occurrence of complications.METHODS: One hundred and twenty patients with severe cerebrovascular diseases who underwent enteral nutrition support therapy at our hospital from October 2011 to September 2013 were included and randomly divided into two groups: an experimental group and a control group, with 60 patients in each group. The experimental group received early enteral nutrition therapy and appropriate care measures, while the control group underwent conventional nutritional treatment. Biochemical indicatorsand the numbers of deaths, complications and sequelae were recorded and compared between the two groups. RESULTS: The effective rate was significantly higher in the experimental group than in the control group(90% vs 35%, P < 0.05). There were no significant differences in food intake, defecation, vomiting and diarrhea, physiological blood pressure, heart rate, Na+, Ca2+ or serum albumin levels between the two groups(P > 0.05 for all). There was one death in the experimental group and seven deaths in the control group. The number of complications was 4 in the experimental group and 12 in the control group. The number of sequelae was 3 in the experimental group and 10 in the control group. CONCLUSION: Appropriate care and early enteral nutrition in critically ill patients can effectively reduce the occurrence of complications and accelerate the recovery of gastrointestinal function.
引文
1 石小峰,史克珊,李安民,陈焕雄.神经外科重症患者上消化道出血高危因素监测与治疗.世界华人消化杂志2002;10:1101-1103
2 王慧,钟燕,蔡东联,耿珊珊,韩婷,陈凌云.添加益生元肠内营养对重症急性胰腺炎肠屏障损害和内毒素易位的作用.世界华人消化杂志2007;15:694-699
3 胡森,王海滨,夏斌,于勇,黎君友,邹晓防,周国勇,车晋伟.通腑颗粒改善犬缺血再灌注状态下实施肠内营养时的小肠功能.世界华人消化杂志2007;15:1845-1849
4 Tyson SF,Brown P.How to measure fatigue in neurological conditions?A systematic review of psychometric properties and clinical utility of measures used so far.Clin Rehabil 2014 Feb 11.[Epub ahead of print][PMID:24519920 DOI:10.1177/0269215514521043]
5 耿梦雅,谢绍英,林善娟.肠内营养防治呼吸机相关性肺炎的研究进展.护士进修杂志2010;25:555-557
6 焦宪法,李伟丽,牛杏果,张科,王小雯,赵玉洁.胃镜下胃管代替鼻肠管在重症患者中应用.中国内镜杂志2012;18:1033-1037
7 郭日康,胡溅梅,陈丽芳,陈纯波,曾文新,叶珩,孙诚.重症患者被动等待法结合补救性盲插法放置螺旋型鼻肠管的可行性.实用医学杂志2012;28:2403-2405
8 Sakurai K,Tokumaru AM,Nakatsuka T,Murayama S,Hasebe S,Imabayashi E,Kanemaru K,Takao M,Hatsuta H,Ishii K,Saito Y,Shibamoto Y,Matsukawa N,Chikui E,Terada H.Imaging spectrum of sporadic cerebral amyloid angiopathy:multifaceted features of a single pathological condition.Insights Imaging 2014Feb 12.[Epub ahead of print][PMID:24519790]
9 李晓红,刘丽颖,李媛媛.鼻胃管与鼻肠管在神经外科重症患者中联合应用的护理.护士进修杂志2013;28:138-139
10 桂培根,吴正茂,曾均发,李方,张凯.3120例危重症患者床旁胃镜放置鼻空肠管的临床应用.中国内镜杂志2012;18:430-431
11 马云飞.肠内营养支持途径与并发症.实用医学杂志2013;29:2400-2402
12 李国艳.重型颅脑损伤病人早期肠内营养的实施及护理.大家健康(下旬版)2013;7:159-159
13 Kingston A,Davies K,Collerton J,Robinson L,Duncan R,Bond J,Kirkwood TB,Jagger C.The contribution of diseases to the male-female disability-survival paradox in the very old:results from the newcastle85 +study.PLoS One 2014;9:e88016[PMID:24516578DOI:10.1371/journal.pone.0088016]
14 忻莹,戴宁.重危患者胃小肠的运动功能紊乱.世界华人消化杂志2002;10:77-79
15 靳雁,郭小花,袁娟,曹灵,韩睿卓,屈圆圆.持续质量改进在食管癌患者术后肠内营养的应用.护士进修杂志2011;26:1945-1946
16 刘亚光,刘若楠.术后危重患者早期肠内营养临床观察:附52例报告.中国普通外科杂志2010;19:445-447
2 王慧,钟燕,蔡东联,耿珊珊,韩婷,陈凌云.添加益生元肠内营养对重症急性胰腺炎肠屏障损害和内毒素易位的作用.世界华人消化杂志2007;15:694-699
3 胡森,王海滨,夏斌,于勇,黎君友,邹晓防,周国勇,车晋伟.通腑颗粒改善犬缺血再灌注状态下实施肠内营养时的小肠功能.世界华人消化杂志2007;15:1845-1849
4 Tyson SF,Brown P.How to measure fatigue in neurological conditions?A systematic review of psychometric properties and clinical utility of measures used so far.Clin Rehabil 2014 Feb 11.[Epub ahead of print][PMID:24519920 DOI:10.1177/0269215514521043]
5 耿梦雅,谢绍英,林善娟.肠内营养防治呼吸机相关性肺炎的研究进展.护士进修杂志2010;25:555-557
6 焦宪法,李伟丽,牛杏果,张科,王小雯,赵玉洁.胃镜下胃管代替鼻肠管在重症患者中应用.中国内镜杂志2012;18:1033-1037
7 郭日康,胡溅梅,陈丽芳,陈纯波,曾文新,叶珩,孙诚.重症患者被动等待法结合补救性盲插法放置螺旋型鼻肠管的可行性.实用医学杂志2012;28:2403-2405
8 Sakurai K,Tokumaru AM,Nakatsuka T,Murayama S,Hasebe S,Imabayashi E,Kanemaru K,Takao M,Hatsuta H,Ishii K,Saito Y,Shibamoto Y,Matsukawa N,Chikui E,Terada H.Imaging spectrum of sporadic cerebral amyloid angiopathy:multifaceted features of a single pathological condition.Insights Imaging 2014Feb 12.[Epub ahead of print][PMID:24519790]
9 李晓红,刘丽颖,李媛媛.鼻胃管与鼻肠管在神经外科重症患者中联合应用的护理.护士进修杂志2013;28:138-139
10 桂培根,吴正茂,曾均发,李方,张凯.3120例危重症患者床旁胃镜放置鼻空肠管的临床应用.中国内镜杂志2012;18:430-431
11 马云飞.肠内营养支持途径与并发症.实用医学杂志2013;29:2400-2402
12 李国艳.重型颅脑损伤病人早期肠内营养的实施及护理.大家健康(下旬版)2013;7:159-159
13 Kingston A,Davies K,Collerton J,Robinson L,Duncan R,Bond J,Kirkwood TB,Jagger C.The contribution of diseases to the male-female disability-survival paradox in the very old:results from the newcastle85 +study.PLoS One 2014;9:e88016[PMID:24516578DOI:10.1371/journal.pone.0088016]
14 忻莹,戴宁.重危患者胃小肠的运动功能紊乱.世界华人消化杂志2002;10:77-79
15 靳雁,郭小花,袁娟,曹灵,韩睿卓,屈圆圆.持续质量改进在食管癌患者术后肠内营养的应用.护士进修杂志2011;26:1945-1946
16 刘亚光,刘若楠.术后危重患者早期肠内营养临床观察:附52例报告.中国普通外科杂志2010;19:445-447