经皮内镜胃造瘘对重度颅脑损伤患者营养支持的疗效评价

目的 观察重度颅脑损伤患者经皮内镜胃造瘘和经鼻胃管行肠内营养后机体营养疗效变化比较以及胃肠道并发症、吸入性肺炎的发生率情况,探讨两者的优劣性.方法 56例重度颅脑损伤患者随机分为两组：实验组30例,采用经皮内镜胃造瘘进行肠内营养支持;对照组26例,采用鼻饲管进行肠内营养支持.肠内营养后第1天、第7天、第21天观察血清白蛋白、血红细胞、淋巴细胞百分比、格拉斯哥昏迷分级评分的变化及胃肠道并发症和吸入性肺炎的发生情况.结果第1、7天对照组同实验组血清白蛋白、血红蛋白、淋巴细胞百分比及格拉斯哥分级评分比较差异无统计学意义（P＞0.05）;第21天实验组血清白蛋白、血红蛋白、淋巴细胞百分比及格拉斯哥分级评分分别为（36.9±177;1.7）g/L、（15.2±177;1.2g）g/dL、（27.3±177;1.7）%、（5.7±177;1.4）分,而对照组分别为（32.7±177;2.9）g/L、（13.0±177;1.5）g/dL、（23.4±177;1.4）%、（4.2±177;1.0）分,两组比较差异有统计学意义（P＆lt;0.05）.两组在胃肠道并发症及吸入性肺炎的发生情况比较差异亦有统计学意义（P＆lt;0.05）.结论 经皮内镜胃造瘘较鼻饲管营养支持治疗在营养恢复以及降低并发症方面优势明显,可在临床上予以推广.

Clinical Efficacy of percutaneous endoscopic gastrotomy in treating of nutritional support in patients with severe craniocerebral injury

Objective To investigate the difference of the nutritional change and the rate of gastrointestinal complications and aspiration pneumonia in patients with severe craniocerebral injury treated by percutaneous endoscopic gastrotomy （PEG） and nasogastric tube respectively. Methods Fifty-six patients with severe eraniocerehral iniury were randomly allocated into two groups including study group （n=30）, in which patients were treated by PEG, and control group （n=26）, in which patients were treated by nasogastric tube. The indexes were investigated which included serum albumin （SA）, hemoglobin （Hb）, lymphocyte percentage fLY）, and Glasgow Coma Scale （GCS） score at the 1st day, 7th day and 21st day after nutritional sup- port. And the rate of gastrointestinal complications and aspiration pneumonia in the two groups were analyzed. Results .At the 1st and 7th day, the difference of SA, Hh, LY and GCS score between two groups were not statistieall.y significant （P= 0.05）. At the 21st day, the SA, Hb, LY and GCS score in study group were （36.9±1.7） g/L, （15.2±1.2） g/dL, （27.3 ±1.7）%, （5.7±1.4） respectively. And they in control group were （32.7±2.9） g/L, （13.0±1.5） g/dL, （23.4± 1.4）%, （4.2±1.0）, respectively. The difference in two groups was statistically significant （P〈0. 05）. Further more, the difference of the rate of gastrointestinal complication and aspirated pneumonia in two groups was statistically significant （P〈 0.05）. Conclusion The clinical effieacy of PEG in treating of nutritional support in patients with severe craniocerebral injury is better than that of nasogastric tube.