规范化鼻饲喂养在降低神经重症患者肠内营养并发症中的应用
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摘要
目的探讨规范化鼻饲喂养对神经重症患者肠内营养并发症的影响。方法选取2014年6月至2016年3月98例神经重症患者作为研究对象,按入组先后顺序等分为对照组和干预组,对照组实施传统肠内营养,干预组实施规范化鼻饲喂养,观察不同喂养方式后营养状况指标(白蛋白、前蛋白、转铁蛋白)含量水平,并发症,急性生理学和慢性健康状况评分(APACHE-Ⅱ)及胃肠道评分变化情况。结果两组患者鼻饲前、鼻饲7 d、鼻饲14 d在白蛋白、前蛋白、转铁蛋白含量水平上比较差异均无统计学意义(P> 0. 05);干预组并发症发生率明显低于对照组(P <0. 05);两组鼻饲7 d、鼻饲14 d在胃肠道评分、APACHE-Ⅱ评分上均低于鼻饲前(P <0. 05),且干预组优于对照组(P <0. 05)。结论规范化鼻饲喂养流程能降低神经重症患者肠内营养并发症,改善胃肠道功能。
Objective To explore the effect of standardized nasogastric gavage process on enteral nutrition complications of patients with severe neurosis. Methods A total of 98 patients with severe neurosis from June 2014 to March 2016 were selected as the study subjects. They were divided into the control group and the intervention group with the same number of patients according to the order of enrollment. The control group was treated with traditional enteral nutrition,while patients in the intervention group was fed with standardized nasogastric gavage. The levels of nutritional status index( albumin,proprotein and transferrin),complications,acute physiology and chronic health evaluation( APACHE-II) score,and changes in gastrointestinal tract scores were observed after the implementation of different feeding methods. Results There were no significant statistical differences in albumin,proprotein and transferrin levels between the two groups before nasogastric gavage,as well as at the 7th day and the 14 th day of nasogastric gavage( P > 0. 05). The incidence of complications in the intervention group was significantly lower than that in the control group( P < 0. 05). The gastrointestinal tract scores and APACHE-II scores of the patients in the two groups at the 7th day and the 14 th day of nasogastric gavage were lower than those before nasogastric gavage( P< 0. 05),and the intervention group was superior to the control group( P < 0. 05). Conclusion Standardized nasogastric gavage process can reduce intestinal enteral complications and improve gastrointestinal function in patients with severe neurosis.
Objective To explore the effect of standardized nasogastric gavage process on enteral nutrition complications of patients with severe neurosis. Methods A total of 98 patients with severe neurosis from June 2014 to March 2016 were selected as the study subjects. They were divided into the control group and the intervention group with the same number of patients according to the order of enrollment. The control group was treated with traditional enteral nutrition,while patients in the intervention group was fed with standardized nasogastric gavage. The levels of nutritional status index( albumin,proprotein and transferrin),complications,acute physiology and chronic health evaluation( APACHE-II) score,and changes in gastrointestinal tract scores were observed after the implementation of different feeding methods. Results There were no significant statistical differences in albumin,proprotein and transferrin levels between the two groups before nasogastric gavage,as well as at the 7th day and the 14 th day of nasogastric gavage( P > 0. 05). The incidence of complications in the intervention group was significantly lower than that in the control group( P < 0. 05). The gastrointestinal tract scores and APACHE-II scores of the patients in the two groups at the 7th day and the 14 th day of nasogastric gavage were lower than those before nasogastric gavage( P< 0. 05),and the intervention group was superior to the control group( P < 0. 05). Conclusion Standardized nasogastric gavage process can reduce intestinal enteral complications and improve gastrointestinal function in patients with severe neurosis.
引文
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[9]罗秀状,陆青梅,李强,等.序贯性肠内营养在危重型手足口病患儿中的应用效果[J].广西医学,2017,39(5):658-660.
[10]王艳萍,江艳,王桂玲,等.早期序贯式肠内营养支持在老年吞咽困难患者中的应用效果研究[J].新疆医科大学学报,2015,5(6):769-771.
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[12]王明将,常敬民.探讨神经重症患者肠内营养合并胃潴留的相关因素分析[J].中国医药指南,2017,15(6):26-27.
[13]郑文博.不同肠内营养输注方式对ICU重症病人营养耐受情况的影响研究[J].中外医疗,2016,35(24):82-84.
[14]黄丽萍,陆玉萍,吴雪燕,等.不同鼻饲泵注方式对危重型颅脑损伤患者肠内营养及并发症的影响[J].湖北民族学院学报(医学版),2017,34(2):41-43.
[2]张丽.集束化护理干预对胃肠道肿瘤术后患者营养学指标及胃肠功能恢复的影响[J].护理实践与研究,2017,14(17):84-86.
[3] Binet A,Klipfel C,Meignan P,et al. Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis:a survey of 407 children[J]. Pediatr Surg Int,2018,34(4):421-426.
[4]吴秀玲,罗玉珍,李润华,等.鼻空肠管营养支持在ICU患者中的应用[J].护理实践与研究,2017,14(4):115-117.
[5]黄丽萍,陆玉萍,吴雪燕,等.不同鼻饲泵注方式对危重型颅脑损伤患者肠内营养及并发症的影响[J].湖北民族学院学报(医学版),2017,34(2):41-43.
[6]沈卫红,沈英,王吉平,等.两种鼻饲法用于急性脑卒中吞咽障碍患者的效果观察[J].神经疾病与精神卫生,2015,5(3):289-292.
[7] Boyer N,Mccarthy MS,Mount CA. Analysis of an electromagnetic tube placement device versus a self-advancing nasal jejunal device for postpyloric feeding tube placement[J]. J Hosp Med,2014,9(1):23-28.
[8] Bito S,Yamamoto J,Tominaqa H,et al. Prospective Cohort Study Comparing the Effects of Different Artificial Nutrition Methods on Long-Term Survival in the Elderly:Japan Assessment Study on Procedures and Outcomes of Artificial Nutrition(JAPOAN)[J].JPEN J Parenter Enteral Nutr,2015,39(4):456-464.
[9]罗秀状,陆青梅,李强,等.序贯性肠内营养在危重型手足口病患儿中的应用效果[J].广西医学,2017,39(5):658-660.
[10]王艳萍,江艳,王桂玲,等.早期序贯式肠内营养支持在老年吞咽困难患者中的应用效果研究[J].新疆医科大学学报,2015,5(6):769-771.
[11] Bechtold ML,Nguyen DL,Palmer LB,et al. Nasal bridles for securing nasoenteric tubes:a meta-analysis[J]. Nutrition in clinical practice:official publication of the american society for parenteral and Enteral Nutrition,2014,29(5):667-671.
[12]王明将,常敬民.探讨神经重症患者肠内营养合并胃潴留的相关因素分析[J].中国医药指南,2017,15(6):26-27.
[13]郑文博.不同肠内营养输注方式对ICU重症病人营养耐受情况的影响研究[J].中外医疗,2016,35(24):82-84.
[14]黄丽萍,陆玉萍,吴雪燕,等.不同鼻饲泵注方式对危重型颅脑损伤患者肠内营养及并发症的影响[J].湖北民族学院学报(医学版),2017,34(2):41-43.