摘要
目的探讨留置经鼻空肠管在重型颅脑外伤（STBI）机械通气患者早期肠内营养中的应用价值。方法选取2013年1至12月收住蚌埠医学院第一附属医院重症医学科的STBI机械通气患者为研究对象，应用随机数字表法分为空肠管组15例和胃管组19例，观察两组患者肠内营养（EN）可以耐受的启动时间、达目标喂养量所需时间和实施EN过程中的胃肠道反应、呼吸机相关肺炎（VAP）等并发症发生情况，以及机械通气和ICU住院时间、28d病死率。结果空肠管组与胃管组EN可以耐受的启动时间[（51.73±9．16）h比（81．11±11．82）h]和达目标喂养量所需时间[（87．27±9．99）h比（152．05±28．74）h]比较，差异均有统计学意义（t值分别为7．920、8．320，均P〈0．05）。实施EN过程中，空肠管组与胃管组并发胃潴留（6．7％比57．9％）、反流（0％比36．8％）、呕吐（20．0％比63．2％）、误吸（6．7％比42．1％）、VAP（33．3％比73．7％）等并发症发生率比较，差异均有统计学意义（，值分别为10．937、9．566、6．642、6．087、5．536，均P〈0．05）；空肠管组与胃管组机械通气时间[（10．73±4．68）d比（15．74±2．54）d]和ICU住院时间[（13．60±4．80）d比（17．42±4．05）d]比较，差异均有统计学意义（t值分别为3．730、2．497，均P〈0．05）；两组患者28d病死率比较，差异无统计学意义。结论对STBI机械通气患者留置经鼻空肠管实施早期EN，有利于减轻喂养不耐受，缩短启动EN和达目标喂养量所需时间，减少并发症的发生，缩短机械通气和ICU住院时间。
Objective To evaluate the use of nasojejunal tube in early enteral nutrition in severe traumatic brain injury （STBI） patients under mechanical ventilation. Methods STBI patients requiring mechani- cal ventilation in intensive care unit （ICU） of the First Affiliated Hospital of Bengbu Medical College admitted in 2013 were randomly divided into the jejunal tube group （n = 15） and gastric tube group （n = 19）. We compared the 2 groups in terms of the tolerable beginning time of enteral nutrition （EN）, the time before reaching target feeding volume, the incidences of gastrointestinal complications and ventilator-associated pneumonia （VAP） during EN, mechanical ventilation time, ICU hospital stay, and 28-day mortality rate. Results The tolerable beginning time of EN [ （51.73 ± 9.16） hours vs. （81.11 ± 11.82） hours, t = 7. 920, P 〈 0. 05 ] and the time required to reach target feeding volume [ （87. 27 ± 9. 99） hours vs. （152. 05 ± 28. 74） hours, t = 8. 320, P 〈 0. 05 ] in the jejunal tube group were significantly shorter than those in the gastric tube group. In the process of EN, compared with the gastric tube group, the incidences of gastric retention （6. 7% vs.57.9%,χ^2=10.937, P〈0.05）, reflux （0% vs. 36.8%,X2 =9.566, P〈0.05）, vomiting （20.0% vs. 63.2%, χ^2 =6.642, P〈0.05）, aspiration （6.7% vs. 42. 1% ,χ^2 =6.087, P〈0.05）, VAP （33.3% vs. 73.7% , χ^2 = 5. 536, P 〈 0. 05 ） in the jejunum tube group were significantly lower. The mechanical ventilation time [ （10.73 ± 4.68） days vs. （15.74 ± 2.54） days, t=3.730, P〈0.05] and the ICU hospital stay [ （13.60 ± 4. 80） days vs. （17.42 ± 4. 05） days, t=2.497, P〈0.05] of the jejunum tube group were significantly shorter than those of the gastric tube group. Comparison of 28-day mortality rate between the two groups revealed no statistically significant difference. Conclusion Early implementation of EN via nasojejunal tube in mechanically ventilated STBI patients can alleviate feeding intolerance, shorten the beginning time of EN and the time required to reach target feeding volume, reduce the incidence of complications, and shorten mechanical ventilation time and hospital stay in ICU.
出处
《中华临床营养杂志》
CAS
CSCD
2015年第1期23-26,共4页
Chinese Journal of Clinical Nutrition
基金
安徽省“十二五”临床重点培育专科建设项目（01P44）
安徽省科技攻关项目（1301042221）
关键词
颅脑外伤
肠内营养
机械通气
Traumatic brain injury
Enteral nutrition
Mechanical ventilation
作者简介
通信作者：汪华学，E-mail：huaxuew2010@163．com
