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自体胃液回输联合肠内营养对重型颅脑损伤胃瘫病人营养吸收的研究

A Study on nutrient absorption of patients with severe craniocerebral injury and gastroparesis by autologous gastric juice reinfusion combined with enteral nutrition
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摘要 目的:探讨自体胃液回输联合肠内营养(EN)对重型颅脑损伤胃瘫病人营养支持的效果及对胃肠道并发症的影响。方法:选取入住神经外科的重型颅脑损伤并发胃瘫病人85例,随机分为回输组和对照组:两组病人均采用鼻空肠管输注营养液联合鼻胃管减压引流的EN方式,回输组把减压引流的胃液经营养管道与EN液混合后回输至空肠;对照组将减压引流胃液弃去,补充等量的温开水。记录两组病人胃液引流量和回输时间;EN后1周、EN后2周两组病人的血清白蛋白、血清总蛋白、血红蛋白的变化及腹胀、腹泻、便秘等胃肠道并发症发生情况。结果:回输组病人开始回输的时间是入院后3~7d;回输持续时间(9.12 ± 3.2) d;24h回输胃液量为(1298.1 ± 629.5) mL,病人均能耐受胃液回输。回输组7 d热量达标率高于对照组(P < 0.05);两组病人EN后2周血清白蛋白,血清总蛋白、血红蛋白水平均得到改善,回输组病人的改善情况均优于对照组(P < 0.05)。回输组病人腹胀、腹泻、发生率均低于对照组(P<0.05),而便秘率发生率无明显差异(P>0.05)。结论:自体胃液回输联合EN能够显著改善重型颅脑损伤胃瘫病人的营养状况.增加病人对EN的耐受性.减少腹胀、腹泻、并发症的发生,是一种安全、经济、有效的营养支持方式,值得临床推广应用。 Objective:To investigate the effect of autologous gastric juice reinfusion combined with enteral nutrition on nutritional support of patients with gastroparesis folllowing severe brain injury and its effect on gastrointestinal complications. Methods: 85 patients with severe craniocerebral injury complicated with gastroparesis were selected and randomly divided into experimental group and control group. Both groups of patients were treated with enteral nutrition with nasojejunal tube combined with nasogastric decompression. The experimental group infused the drained gastric juice into the jejunum together with other enteral feedings. The control group, in contrast, discarded the gastric juice and replace the same amount of warm water. Changes of serum albumin, serum total protein and hemoglobin in two groups at the time of admission, 1 week after enteral nutrition and 2 weeks after enteral nutrition;and abdominal distension, diarrhea, constipation and other gastrointestinal complications were recorded . Results: The patients in the experimental group began to reinfuse the gastric juice 3 ?7 days after admission. The duration of reinfusion was (9.12 ± 3.2) days, and the amount of 24 h gastric juice reinfusion was (1298.1 ±629.5) mL. All patients tolerated reinfusion of gastric juice well without aspirational complications. Calorie qualifying rate at 7d in the experimental group was significantly higher than that in the control group (P < 0.05);The serum albumin, serum total protein and hemoglobin levels of the two groups were improved on 2 weeks after enteral nutrition, The improvement of the patients in the experimental group was better than that in the control group (P < 0.05).The incidence of abdominal distention, diarrhea and constipation in the experimental group was lower than that in the control group (P < 0.05), but there was no significant difference in terms of the incidence of constipation (P > 0.05). Conclusions Autologous gastric juice reinfusion combined with enteral nutrition can significantly impr
作者 王洪岩 王玉果 李梅花 王俊伟 安冉冉 王树君 李勐 WANG Hong-yan;WANG Yu-guo;LI Mei-hua;WANG Jun-wei;AN Ran-ran;WANG Shu-jun;LI Meng(Department of neurosurgery, Binzhou Medical University Hospital, Binzhou 256603,Shandong,China)
出处 《肠外与肠内营养》 CSCD 北大核心 2019年第4期219-222,227共5页 Parenteral & Enteral Nutrition
基金 山东省自然科学基金(ZR2017LH033) 滨州医学院科技计划项目(BY20I4KJ46).
关键词 重型颅脑损伤 胃瘫 胃液回输 肠内营养 Severe eraniocerebral injury Gastroparesis Gastric fluid reinfusion Enteral nutrition
作者简介 王洪岩,副主任护师,护理本科,从事临床护理学研究。E-mail:why6928@163.com;通讯作者:李勐,E-mail:Iimeng5656@163.com.
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