早期肠内营养支持对急性缺血性卒中伴吞咽困难患者的影响

目的探讨早期肠内营养支持对急性缺血性脑卒中伴吞咽困难患者的营养状况及肺部感染的影响。方法将急性缺血性脑卒中伴吞咽困难患者58例随机分为2组：标准营养组30例，采用能全力按83．74～125．60J／（kg·d）标准配制，经鼻饲管滴注；匀浆膳食组28例，采用自行混制而成匀浆汤液200mL／次，经鼻饲管注入，4～6次／d。分别于入院第1、10天测定血清白蛋白（ALB）、血清前白蛋白（PA），观察2组患者营养指标的变化以及肺部感染发生率。结果标准营养组入院治疗第10天与入院第1天比较ALB、PA值下降不明显（均P〉0．05）；匀浆膳食组入院治疗第10天与入院第1天比较，ALB[（34．3±2．1）g／L vs （38．8±2．1）g／L]、PA[（158．3±22．1）mg／L vs （198．6±30．8）mg／L]均有降低（均P〈0．05）。入院第10天，标准营养组ALB为（38．5±2．2）g／L、PA为（192．8±26．4）mg／L，均高于匀浆膳食组[ALB（34．3±2．1）g／L、PA（158．3±22．1）mg／L]（均P〈0．05）。标准营养组肺部感染发生率明显低于匀浆膳食组（26．7％VS35．7％，P〈0．05）；肺部感染患者其人院时ALB低于无并发肺部感染患者[（33．4±5．6）g／L vs （42．5±3．7）g／LP〈0．05]。结论早期肠内营养可减缓急性缺血性脑卒中并发吞咽困难患者营养状况恶化，降低肺部感染的发生率。

The Effect of Early Enteral Nutrition Support on Acute Ischemic Stroke Patients with Dysphagia

Objective To discuss the effect of early enteral nutrition support on nutritional status and pneumonia in acute ischemic stroke patients with dysphagia. Methods Fifty-eight acute ischemic stroke patients with dysphagia were randomly allocated into standard nutrition group （n=30） and common diet group（n=28）. All the patients were fed with enteral nutrients through nasogastric tube after admission. The patients in standard nutrition group were fed by Nutrison Fibre with 83.74-125.60 J/（kg.d）. Whereas those in common diet group were fed by liquid diet with 200 mL one time,4-6 times everyday. Serum albumin（ALB） level and Serum prealbumin （PA） level were measured on the first day and tenth day post-admission. The incidence of pneumonia was measured also. Results The levels of ALB and PA on the tenth day post-admission in the standard nutrition group were comparable with those on the first day（P〉0.05）. Whereas the levels of ALB and PA deceased significantly in the common diet group[（ALB（38.8±2.1） g/L vs （34.3±2.1）g/L;PA（198.6±30.8）mg/L vs （158.3±22.1）mg/L,P〈0. 05]. The levels of ALB and PA in standard nutrition group were higher than these in common diet group[ALB（38.5± 2.2）g/L vs （34.3±2.1）g/L,PA（192.8±26.4）mg/L vs （158.3±22. 1）mg/L,P〈0.05）]. Compared with the common diet group, the incidence of pneumonia was lower in the standard nutrition group（26.7% vs 35.7% ,P〈0.05）. The level of ALB on the admission day was lower in these patients with pneumonia [ALB（33.4± 5.6）g/L vs （42.5±3.7）g/L, P〈0.05）]. Conclusion Early enteral nutrition support could alleviate the deterioration of the nutritional status and decrease the incidence of pneumonia in acute ischemic stroke patients with ctysphagia.