鼻空肠置管与鼻胃置管两种不同置管方式在改善重型颅脑损伤亚低温状态下早期肠内营养支持中的疗效比较

目的探讨鼻空肠置管与鼻胃置管两种不同置管方式在改善重型颅脑损伤亚低温状态下早期肠内营养支持中的作用，并比较其临床疗效。方法选择120例进行常规亚低温治疗的重型颅脑损伤患者，按简单随机抽样法分为鼻空肠置管肠内营养（鼻空肠置管组）60例及鼻胃置管肠内营养（鼻胃置管组）60例，实施鼻胃置管及鼻空肠置管后，使用肠内营养要素膳和／或肠内高营养多聚合剂实施早期肠内营养支持，两组患者在肠功能存在条件下48h内开始肠内营养，比较两组各项营养指标以及不良反应、并发症和格拉斯哥昏迷量表（GCS）评分、急性生理学与慢性健康状况11（APACHElI）评分等。结果两组患者经过早期肠内营养，营养指标均有改善，入院第14、28天，鼻空肠置管组患者的肱三头肌皮褶厚度、上臂肌围、血清白蛋白、前白蛋白、转铁蛋白、血红蛋白等指标上升幅度均明显高于鼻胃置管组，差异有统计学意义（P〈0．05）。鼻空肠置管组患者腹泻、腹胀、呕吐、胃内容物潴留及反流发生率明显低于鼻胃置管组5．0％（3／60）比18．3％（11／60）、10．0％（6／60）比21．7％（13／60）、5．0％（3／60）比21．7％（13／60）、15．0％（9／60）比16．7％（10／60）、11．7％（7／60）比48．3％（29／60）、8．3％（5／60）比21．7％（13／60）]，差异有统计学意义（尸〈O．05）。鼻空肠置管组并发症发生率低于鼻胃置管组16．7％（10／60）比76．7％（46／60）]，差异有统计学意义（P〈0．05）。鼻空肠置管组GCS评分、APACHEⅡ评分均较鼻胃置管组明显改善，差异有统计学意义（P〈0．05）。结论早期鼻空肠置管肠内营养对于重型颅脑损伤后亚低温状态下临床肠内营养实施是可行的、合理的，与鼻胃置管比较，能明显减少肠内营养的并发症，较早地达到目标营养治疗量，可以改善预后。

Nasal jejunal tube and nasogastric tube of two different catheter ways in improving the severe craniocerebral injury and the low temperature condition compared the curative effect of early enteral nutrition support

Objective To investigate the application of nasal jejunal tube and nasogastfic tube of two different catheter ways in improving the severe craniocerebral injury and the low temperature condition and the role of early enteral nutrition support and compare the difference between its curative effect. Methods A total of 120 patients with severe eraniocerebral injury underwent normal and low temperature treatment were selected, and they were divided into nasal jejunal tube enteral nutrition （nasal jejunal tube group, 60 cases ） and nasogastric tube enteral nutrition （nasogastric tube group, 60 cases ） by simple random sampling. After implement nasogastrie tube and nasal jejunal tube, normal pressure using enteral nutrition elementaldiet and/or enteral nutrition multi polymerization agent produced the best nutrient solution implementation of early enteral nutrition support, two groups of subjects under the condition of bowel function exists, within 48 h starting enteral nutrition, compared two groups of various nutrition indicators as well as adverse reactions and complications, and Glasgow Coma Scale （GCS） score, Acute Physiology and Chronic Health Evaluation （APACHE Ⅱ ） score, etc. Results The patients with severe eraniocerebral injury after early nutrition,the various nutrition indicators had improved in two groups. The rise extent of triceps skinfold thickness, arm muscle circumference, serum albumin, prealbumin, transferrin, hemoglobin and other indicators in nasal jejunal tube group was higher than that in nasogastric tube group on the 14th, 28th day after admission, and there was significant difference （P 〈 0.05）. The incidence of diarrhea, bloating, vomiting, and stomach contents reflux retention in nasal jejunal tube group was lower than that in nasogastric tube group 5.0% （3/60）vs. 18.3%（11/60）, 10.0%（6/60） vs. 21.7%（13/60） ,5.0% （3/60） vs. 21.7%（13/60）, 15.0% （9/60） vs. 16.7% （10/60）,11.7% （7/60） vs. 48.3% （29/60）,8.3% （5/60） vs. 21.7% （13/60）],and there was significant difference （P 〈 0.05 ）. The incidence of complications in nasal jejunal tube group was lower than that in nasogastric tube group 16.7%（10/60） vs. 76.7%（46/60）] ,and there was significant difference （P〈 0.05 ）. The changes of GCS score, APACHE score in nasal jejunal tube group was more obvious than that in nasogastric tube group, and there was significant difference （P 〈 0.05 ）. Conclusions Early nasal jejunal tube enteral nutrition for the severe craniocerebral injury after the low temperature condition in clinical enteral nutrition implementation is feasible and reasonable, compared with a nasogastric tube feeding, can obviously reduce the complications of enteral nutrition and reach goals earlier nutritional therapy, can imp＇rove the prognosis.