不同时期的肠内营养对脑卒中后吞咽障碍患者免疫功能、营养指标、神经功能缺损的影响

摘要

目的 探讨不同时期的肠内营养对脑卒中后吞咽障碍患者免疫功能、营养指标、神经功能缺损的影响.方法 选取本院收治的脑卒中后吞咽障碍患者203例,依据实施肠内营养支持的时期不同,分为入院当天开始鼻饲的患者记为观察组(105例)和入院第4天开始鼻饲的患者记为对照组(98例).比较两组患者住院期间免疫功能、营养指标(TLC、IgG、IgA、Hb、ALB、STP)、神经功能缺损评分(NIHSS)以及并发症情况.结果 治疗2w后,对照组的TLC、IgG、IgA、Hb、ALB、STP指标均明显低于观察组;两组患者治疗前后组内对比,各项免疫指标、各项营养指标差异无统计学意义(P>0.05).治疗4w后,观察组NIHSS评分明显低于对照组;两组患者治疗前后组内对比,观察组治疗2w、治疗4w后,NIHSS评分明显低于治疗前(P<0.05).对照组治疗4w后,NIHSS评分明显低于治疗前(P<0.05).观察组肺部感染及总并发症发生率均明显低于对照组,差异有统计学意义(均P<0.05).结论 早期肠内营养能有效改善脑卒中后吞咽障碍患者免疫功能和营养状况,促进神经功能缺损的恢复,同时降低并发症,提高预后效果.%Objective To explore the different periods of enteral nutrition on immune function of patients with dysphagia after stroke, nutrition index, effect of nerve function defect.Method Two hundred and three cases of dysphagia of stroke patients in our hospital were selected, according to the implementation of enteral nutrition in different period, divided into the admission day began feeding the patients were assigned to the observation group (one hundred and five cases) and on the 4d start nasal feeding patients as control group (ninety eight cases). Compared two groups of patients hospitalized during the immune function, nutritional index, neurological deficit score and complications.Results After 2 weeks of treatment, the TLC,IgG,IgA, Hb,ALB and STP of control group were significantly lower than those in the observation group; but the intra-group comparison of two groups before and after treatment, the immune and the nutritional indicators had no statistically significant(P>0.05); After 4 weeks of treatment, the NIHSS score of the observation group was significantly lower than the control group; For all the intro-group comparison of two groups after treated for 2 weeks and 4 Weeks, the NIHSS score of observation group was significantly lower than before treatment(P<0.05), but the NIHSS score of the control group was significantly lower than before treatment after treated for 4 weeks(P<0.05).Furthermore, the pulmonary infection and total complication rate of observation group were significantly lower than the control group, the differences were statistically significant (P<0.05).Conclusion Early enteral nutrition can effectively improve the immune function and nutritional status of patients with dysphagia after stroke, and promote the recovery of neurological function, reduce complications andimprove prognosis.