吞咽功能障碍的老年重症患者经鼻肠管和鼻胃管肠内营养的比较

摘要

Objective To compare the efficiency and complication incidence of the 2 routes of enteral nutrition(EN), through naso-jejunal tube and nasogastric tube, for critically ill elderly patients with swallowing dysfunction in order to explore more safe and effective way of EN. Methods A total of 53 critically ill elderly patients with swallowing dysfunction admitted in our hospital from January 2012 to November 2014 were recruited in this study. They were randomly divided into 2 groups according to different routes of EN, indwelling naso-jejunal tube (n=31), and indwelling nasogastric tube (n=22). In 2 weeks after EN, the nutrition indicators, incidences of complications and clinical outcomes were observed and compared between the 2 groups. Results Compared with the patients using nasogastric tube, those with naso-jejunal tube had more significantly elevated prealbumin, and obviously lower incidences of gastrointestinal complications and aspiration pneumonia (P<0.05). However, no significant difference was seen in mechanical ventilation frequency and mortality between the 2 groups (P>0.05). Conclusion Naso-jejunal tube for EN is more safe and effective for the critically ill elderly patients with swallowing dysfunction.%目的：比较经鼻肠管和鼻胃管两种途径在伴有吞咽功能障碍的老年重症患者中的肠内营养（EN）支持的效果及并发症情况，以选择更安全有效的EN途径。方法选取2012年1月至2014年11月在南京市市级机关医院重症医学科住院的伴有吞咽功能障碍的老年患者共53例进行EN，将患者随机分为留置鼻胃管组（31例）和留置鼻空肠管组（22例）。EN 2周后观察两组的营养指标情况、并发症发生率及预后，进行比较及统计分析。结果两组患者中鼻空肠管组前白蛋白升高更显著，胃肠道并发症及吸入性肺炎发生率均显著下降，差异存在统计学意义（P＜0.05）。但机械通气率和病死率两组相比差异无统计学意义（P＞0.05）。结论伴有吞咽功能障碍的老年重症患者应用鼻空肠管给予EN更为安全、有效。