胃镜辅助下鼻空肠管置入及空肠营养在神经内科重症监护病房中的应用

摘要

目的 探讨胃镜辅助下鼻空肠管置入及空肠营养在神经内科重症监护病房(NICU)中的应用价值.方法 前瞻性分析该院NICU 2014年5月-2017年5月收治的重症脑血管病患者共56例.上述患者均于入院后72 h内发现胃残余量增多(>100 ml).鼻空肠组行床旁鼻胃镜导丝引导置入并行鼻空肠营养共28例,对照组继续给予普通胃管置入并行肠内营养共28例.对比两组患者胃肠道并发症(包括呕吐、反流、腹胀、腹泻、应激性溃疡)发生率、营养状态参数(包括血清白蛋白、前白蛋白、血红蛋白)、医院获得性肺炎(HAP)发生率、炎症指标[包括血白细胞计数(WBC)、降钙素原(PCT)、C反应蛋白(CRP)]、入住NICU时间、NICU费用、格拉斯哥昏迷评分(GCS)、病死率.结果 经鼻胃镜导丝引导下鼻空肠管置入成功率100.0%.鼻空肠组营养状态参数优于对照组,入住NICU时间较短、NICU费用较低,炎症指标较低,两组胃肠道并发症发生率、HAP发生率、GCS评分和病死率差异无统计学意义.结论 对于NICU胃残余量增多的患者经胃镜辅助下置入鼻空肠管行空肠营养值得推荐.%Objective To investigate the value of endoscopic assisted nasal jejunal tube placement and jejunum nutrition in treatment of critically illed patients. Methods This study was a prospective study. 56 patients with severe cerebrovascular diseases in the department of NICU from May 2014 to May 2017 were enrolled in this study. All of the patients were found to have an increased gastric remnant within 72 hours after admission (>100 ml). In the nasal jejunal group, 28 patients received nasal endoscopy and nasal endoscopic feeding, and 28 cases were treated with routine nasogastric tube and enteral nutrition. Comparing the two groups of patients with gastrointestinal complications (including vomiting, gastroesophageal reflux, abdominal distension, diarrhea, stress ulcer incidence) and nutritional status parameters (including serum albumin, prealbumin, hemoglobin), incidence of hospital acquired pneumonia and inflammation indexes (including WBC, PCT and CRP), stay at NICU time, NICU expenses, GCS score and mortality rate. Results The success rate of nasal intestinal tube placement under nasal endoscopy guided wire was 100.0%. The nasal jejunal nutrition status parameters were better, NICU check-in time was shorter, NICU expenses were lower, and the inflammation index was lower than the control group. There were no significant differences in the incidence of gastrointestinal complications, the incidence of hospital acquired pneumonia, the GCS score and the fatality rate between the two groups. Conclusion For the patients with severe gastric remnant increase in NICU, it is worth recommending that naso jejunal tube be inserted into the jejunum by endoscopy and using jejunum nutrition.