早期肠内营养支持对脑卒中后重症吞咽障碍患者预后的影响

目的 探讨早期肠内营养支持对急性脑卒中后重症吞咽障碍患者预后的影响.方法 将符合才藤氏吞咽障碍7级评价法1级标准的139例急性脑卒中后吞咽障碍患者随机分成早期肠内营养组(EEN,n=69)和早期肠外营养组(EPN,n=70),在给予综合治疗的基础上,采用不同方法的营养支持,观察两组治疗前及治疗4w后血清白蛋白,非瘫痪侧上臂三头角肌肌围(MAMC)、三头肌皮褶厚度(TSF)等体重相关营养指标的变化及腹胀、应激性溃疡、肺部感染、病死率等临床并发症发生情况.结果 治疗4w后后,EEN组在营养学指标:血清白蛋白、TSF、MAMC、体重优于EPN组,差异有统计学意义(P<0.05),EEN组并发症发生数小于EPN组,其中并发应激性溃疡、肺部感染者差异有统计学意义(P<0.05),其余差异无统计学意义.结论 重症吞咽障碍是影响脑卒中神经功能康复的因素之一,也是加剧营养状况恶化、并发症发生的主要诱因,脑卒中合并重症吞咽困难患者早期应用肠内营养支持,可改善机体的营养状况,减少并发症发生,有利于患者的康复.

Effects of early enteral nutritional supplementation on prognosis of patients with cysphagia following acute stroke

Objective To study the effects of early enteral nutritional supplementation on prognosis of patients with dysphagia following acute stroke.Methods 139 patients with dysphagia after acute stroke were randomly divided into early enteral nutrition group(EEN,n=69)and early parenteral nutrition group(EPN,n=70).Two groups were treated by different nutritional support treatment on the basis of comprehensive treatment.The hospital nutrition parameters including serum albumin,midarm muscle circumference(MAMC),triceps skinfold thickness(TSF)and weight and incidence rate of complications including tympanites,stress-induced ulcer,pulmonary infection and death rate before therapy and 4 weeks after therapy were observed.Results After treatment of 4 weeks,serum albumin,MAMC,TSF and weight in the EEN group were better than those in the EPN group(P<0.05),and the incidence of stress-induced ulcer and pulmonary infection in the EEN group were obviously less than those in the EPN group(P<0.01).Conclusion The advantages of early enteral nutritional supplementation in patients with dysphagia following acute stroke are improve the nutritional status of the body,reduce the incidence of complications and Conducive to the rehabilitation of patients.