鼻饲管联合精细护理对脑卒中患者肠内营养和肺部感染的影响
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摘要
目的探讨鼻饲管联合精细护理对脑卒中患者肠内营养和肺部感染的影响。方法将2016年4月～2018年3月辽宁省大连市中心医院神经内科收治的116例脑卒中患者,按随机数字表法将其分为对照组和观察组,每组各58例。对照组给予鼻饲管联合常规护理治疗,观察组给予鼻饲管联合精细护理治疗,比较两组患者护理后的营养指标、免疫水平、美国国立卫生研究院卒中量表评分(NIHSS)和肺感染率。结果护理后,两组患者的营养指标均较护理前上升,且观察组患者的营养指标高于对照组,差异有统计学意义(P <0.05);两组患者的IgG、IgA和IgM水平均较护理前下降,但观察组患者的IgG、IgA和IgM水平高于对照组,差异有统计学意义(P <0.05);两组患者的NIHSS评分均较护理前下降,且观察组患者的NIHSS评分低于对照组,差异有统计学意义(P <0.05);观察组肺部感染率为10.31%,明显低于对照组(25.90%),差异有统计学意义(P <0.05)。结论鼻饲管联合精细护理能保证脑卒中患者体内的营养供给,抵抗机体的应激作用及降低肺部感染发生,促进患者的免疫功能和神经功能恢复。
Objective To explore the effects of nasal feeding tube combined with careful nursing on enteral nutrition and pulmonary infection in cerebralstroke patients. Methods From April 2016 to March 2018, 116 patients with cerebralstroke admitted into the Department of Nursing in Dalian Central Hospital were divided into control group and observation group according to random number table method, with 58 cases in each group. The control group was given nasal feeding tube combined with routine nursing treatment, and the observation group was given nasal feeding tube combined with careful nursing treatment. The nutrition index, immunity level, the score of national institutes of health stroke scale score(NIHSS) and the rate of pulmonary infection were compared between the two groups. Results After nursing, the levels of nutritional indicators in the two groups all increased, and those in the observation group were higher than those in the control group, the differences were statistically significant(P < 0.05). The levels of IgG, IgA and IgM all descended, and the levels of IgG, IgA and IgM in the observation group were higher than those in the control group, the differences were statistically significant(P < 0.05). The NIHSS scores of patients in both groups were lower than those before nursing, and the NIHSS scores of patients in the observation group were lower than those in the control group, the differences were statistically significant(P < 0.05). The rate of pulmonary infection in the observation group was 10.31%, which was significantly lower than that 25.90% in the control group, the difference was statistically significant(P < 0.05). Conclusion Nasal feeding tube combined with fine nursing can ensure the nutrition supply in stroke patients, resist the stress effect of the body, reduce the occurrence of pulmonary infection, and promote the recovery of patients′ immune function and neurological function.
Objective To explore the effects of nasal feeding tube combined with careful nursing on enteral nutrition and pulmonary infection in cerebralstroke patients. Methods From April 2016 to March 2018, 116 patients with cerebralstroke admitted into the Department of Nursing in Dalian Central Hospital were divided into control group and observation group according to random number table method, with 58 cases in each group. The control group was given nasal feeding tube combined with routine nursing treatment, and the observation group was given nasal feeding tube combined with careful nursing treatment. The nutrition index, immunity level, the score of national institutes of health stroke scale score(NIHSS) and the rate of pulmonary infection were compared between the two groups. Results After nursing, the levels of nutritional indicators in the two groups all increased, and those in the observation group were higher than those in the control group, the differences were statistically significant(P < 0.05). The levels of IgG, IgA and IgM all descended, and the levels of IgG, IgA and IgM in the observation group were higher than those in the control group, the differences were statistically significant(P < 0.05). The NIHSS scores of patients in both groups were lower than those before nursing, and the NIHSS scores of patients in the observation group were lower than those in the control group, the differences were statistically significant(P < 0.05). The rate of pulmonary infection in the observation group was 10.31%, which was significantly lower than that 25.90% in the control group, the difference was statistically significant(P < 0.05). Conclusion Nasal feeding tube combined with fine nursing can ensure the nutrition supply in stroke patients, resist the stress effect of the body, reduce the occurrence of pulmonary infection, and promote the recovery of patients′ immune function and neurological function.
引文
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[14]叶江华.优质护理对消化性溃疡患者肠黏膜分泌型免疫球蛋白IgA的影响[J].实用临床医药杂志,2015,19(12):47-49,53.
[15]唐桂华,马荣,丘东海,等.不同时期的肠内营养对脑卒中后吞咽障碍患者免疫功能、营养指标、神经功能缺损的影响[J].脑与神经疾病杂志,2017,25(6):340-343.
[16]卢虹,郭艳欢,黄巧.肠内营养支持联合早期康复护理对高血压脑出血患者的影响[J].齐鲁护理杂志,2018,24(12):99-101.
[17]于芬.危重患者机械通气期间实施肠内营养并发症的护理预防[J].中国医药科学,2018,8(2):90-92,116.
[18]伞建超,吕政.综合护理干预对缺血性脑卒中患者神经功能恢复的影响[J].中国医药导报,2018,15(5):144-147.
[19]钟丽梅.精细护理对肝硬化并上消化道出血行食管静脉套扎治疗患者的影响研究[J].中国医药科学,2017,7(21):114-117.
[20]朱定蓉,陈芳.探讨精细化护理模式在传染病患者中的应用价值[J].中国现代医生,2018,56(6):153-155.
[21]陈建英,吴立军.精细管理在五官科护理安全中的应用[J].中国现代医生,2017,55(1):153-156.
[22]王晓燕.早期护理干预对重度颅脑外伤患者神经功能恢复和日常生活活动能力的影响[J].中国康复医学杂志,2014,29(1):65-66.
[2]Teuschl Y,Trapl M,Ratajczak P,et al.Systematic dysphagia screening and dietary modifications to reduce strokeassociated pneumonia rates in a stroke-unit[J].PLoSOne,2018,13(2):e0192142.
[3]胡晓琴,方明,付楠良.鼻空肠管管饲对重症脑卒中患者营养状况及肺部感染的影响[J].中华危重症医学杂志:电子版,2015,8(6):368-370.
[4]侯东哲,张颖,巫嘉陵.中文版美国国立卫生院脑卒中量表的信度与效度研究[J].中华物理医学与康复杂志,2012,34(5):372-374.
[5]徐荣薇.重症脑卒中患者鼻饲反流误吸的护理策略[J]中国实用医药,2016,11(3):199-200.
[6]陈光付.精细护理干预预防脑卒中昏迷患者便秘的整体效果[J].现代医药卫生,2017,33(9):1404-1406.
[7]Chu J,Liu X,Chen F,et al.Effects of GAO's neck acupuncture on swallowing function and quality of life in patients with post-stroke pseudobulbar palsy:a randomized controlled trial[J].Zhongguo Zhen Jiu,2017,37(7):691-695.
[8]曹娟,张小燕,苏永静,等.重症脑卒中患者早期肠内营养的研究进展[J].当代护士:中旬刊,2018,25(1):4-8.
[9]杨小云,丁进,陈燕萍,等.早期肠内营养支持对ICU脑卒中患者免疫功能及肠道黏膜屏障的影响[J].中国临床药理学与治疗学,2016,21(8):935-938.
[10]袁景,林桦,沈宏华,等.脑卒中后便秘治疗进展[J].中国实用神经疾病杂志,2016,19(11):96-98.
[11]吴咏梅,陶茹莹,孟祥宝,等.缺血性脑卒中损伤机制研究进展[J].吉林中医药,2018,38(3):368-372.
[12]李莹,代健,张嵩,等.早期肠内营养支持对伴吞咽困难的急性脑梗死患者的临床应用价值[J].世界华人消化杂志,2016,24(4):618-622.
[13]凌海华.早期肠内营养支持对重症脑卒中患者营养和免疫功能的影响[J].临床合理用药杂志,2016,9(18):99-101.
[14]叶江华.优质护理对消化性溃疡患者肠黏膜分泌型免疫球蛋白IgA的影响[J].实用临床医药杂志,2015,19(12):47-49,53.
[15]唐桂华,马荣,丘东海,等.不同时期的肠内营养对脑卒中后吞咽障碍患者免疫功能、营养指标、神经功能缺损的影响[J].脑与神经疾病杂志,2017,25(6):340-343.
[16]卢虹,郭艳欢,黄巧.肠内营养支持联合早期康复护理对高血压脑出血患者的影响[J].齐鲁护理杂志,2018,24(12):99-101.
[17]于芬.危重患者机械通气期间实施肠内营养并发症的护理预防[J].中国医药科学,2018,8(2):90-92,116.
[18]伞建超,吕政.综合护理干预对缺血性脑卒中患者神经功能恢复的影响[J].中国医药导报,2018,15(5):144-147.
[19]钟丽梅.精细护理对肝硬化并上消化道出血行食管静脉套扎治疗患者的影响研究[J].中国医药科学,2017,7(21):114-117.
[20]朱定蓉,陈芳.探讨精细化护理模式在传染病患者中的应用价值[J].中国现代医生,2018,56(6):153-155.
[21]陈建英,吴立军.精细管理在五官科护理安全中的应用[J].中国现代医生,2017,55(1):153-156.
[22]王晓燕.早期护理干预对重度颅脑外伤患者神经功能恢复和日常生活活动能力的影响[J].中国康复医学杂志,2014,29(1):65-66.