脑卒中后吞咽障碍患者经皮内镜下胃造瘘肠内营养的护理体会

目的 探讨脑卒中后吞咽障碍患者经皮内镜下胃造瘘(percutaneous endoscopic gastrostomy,PEG)行肠内营养的效果.方法 68例脑卒中后吞咽障碍患者根据肠内营养的方式不同分为PEG组(34例)和鼻胃管(nasogastric tube,NGT)组(34例).比较两种肠内营养途径的相关并发症及营养改善效果.结果 PEG组与NGT组比较,PEG组胃潴留(14.7％ vs.32.4％),反流性食管炎(11.8％ vs.23.5％),吸入性肺炎(17.6％ vs.38.2％)均较NGT组显著降低(P＜0.05);PEG组营养治疗3个月的BMI (20.56±1.32) kg/m2 vs.(19.97±1.35) kg/m2],ALB (40.45±2.12)g/L vs.(38.27±2.25) g/L],前白蛋白(PA)均高于NGT组(302.12±30.28) mg/L vs.(280.27±28.17) mg/L],差异均有统计学意义(P＜0.05).结论 脑卒中后吞咽障碍患者PEG行肠内营养是一种安全、有效的营养支持方法,促进疾病康复,提高患者生活质量.

Clinical observation of enteral nutritional suspension for patients with dysphagia after stroke

Objective To investigate the strategies for nursing the cerebrovascular disorder(CVD) patients with dysphagia who were treated with enteral nutrition for percutaneous endoscopic gastrostomy(PEG).Methods A total of 68 elderly patients with dysphagia after stroke were randomly divided into 2 groups.Observation group(n=34) were managed with enteral nutrition for PEG and the control group(n=34) received enteral nutrition for nasogastric tube (NGT).The differences of enteral nutrition related gastrointestinal complications and body nutrition indexes were evaluated before and after treatment.Results Compared with the NGT group,the complications of gastric retention (14.7％vs.32.4％,P＜0.05),reflux esophagitis (11.8％vs.23.5％,P＜ 0.05)and aspiration pneumonia(17.6％vs.38.2％,P＜0.05) significantly reduced in PEG group.After 3 months treatment,the levels of BMI (20.56±1.32) kg/m2 vs.(19.97±1.35 )kg/m2,P＜0.05],albumin (40.45±2.12) g/L vs.(38.27±2.25) g/L,P＜0.05] and pre-albumin(302.12±30.28) mg/L vs.(280.27±28.17) mg/L,P＜0.05] in PEG group significantly increased compared to the NGT group.Conclusion For CVD patients with dysphagia,enteral nutrition for percutaneous endoscopic gastrostomy is a safe and effective nutritional support.The nursing strategies including the care of ostomy catheter,monitoring of enteral nutrition and prevention of complications may ensure the smooth implementation of enteral nutrition,prompt recovery and improve their quality of life.