高龄患者肠内营养支持口服与鼻饲的效果比较

目的　比较口服营养（oral nutritional supplements，ONS）和鼻饲营养（nasal feeding nutrition，NF），包括鼻胃管营养（nasogastric tube nutrition，NGT）、鼻空肠管营养（naso-jejunal tube nutrition，NJT），对高龄（≥80岁）住院患者行营养支持的效果。方法　选择2018年9月至2021年12月入住江苏大学附属连云港医院老年科、呼吸科、急诊科、胃肠外科、肝胆外科、神经内外科、重症医学科等的高龄患者108例，对其肠内营养（enteral nutrition，EN）的支持情况进行分析，根据EN支持方式将其分为ONS组（50例，男31例，女19例）和NF组（58，男38例，女20例），NF组包括鼻胃管营养组（NGT组）40例和鼻空肠管营养组（NJT组）18例。患者年龄80～98岁，ONS组患者平均年龄85.7岁，NF组患者平均年龄84.9岁。EN支持时间均>14 d，摄入同等热量和同等氮量。分别在营养支持前1 d和营养支持后第7天、第14天检测血清前清蛋白（prealbumin，PA）、总蛋白（total protein，TP）、白蛋白（albumin，ALB）、血红蛋白（hemoglobin，Hb）和红细胞（red blood cell，RBC）计数，以及炎症因子C反应蛋白（C-reactive protein，CRP）、白介素6（interleukin-6，IL-6）、降钙素原（procalcitonin，PCT）、肿瘤坏死因子α（tumor necrosis factor，TNF-α），免疫指标CD3+、CD4+、CD8+、免疫球蛋白（Ig）G、IgA、IgM。比较ONS组、NGT组、NJT组上述指标的差异。采用SPSS 18.0软件进行数据分析，计量资料采用t检验、F检验，计数资料采用χ^２检验，P≤0.05为差异有统计学意义。结果　3组高龄患者蛋白质营养状况在EN支持前差异无统计学意义（P>0.05）；EN支持后，3组血清PA、TP、ALB水平均显著增加，CRP、IL-6、PCT、TNF-α均显著降低，差异有统计学意义（均P<0.05），而Hb和RBC计数未显著增加（均P>0.05）。ONS组IgG、IgA、IgM、CD3+、CD4+高于NGT组、NJT组同期（均P<0.05），CD8+低于NGT组、NJT组同期（均P<0.05）。治疗后14 d，ONS组腹泻（6%，3/50）、反流（8%，4/50）、消化道出血（2%，1/50）与NGT组、NJT组同时间点比较，差异均有统计学意义（均P<0.05）；ONS组呕吐（4%，2/50）、再发肺部感染并发症（4%，2/50）与NGT组同时间点比较，差异均有统计学意义（均P<0.05），与NJT组同时间点比较，差异均无统计学意义（均P>0.05）。结论　在高龄老年患者（≥80岁）EN支持中，ONS和NF支持均能有效改善老年患者的蛋白质营养状况，其中ONS效果更加显著，对高龄患者的EN能够显著缓解病情严重程度，改善患者炎症介质、氧化应激水平，降低并发症发生率，疗效确切。

Effects of oral and nasal enteral nutrition supports for elderly patients

Objective　To compare the effects of oral nutritional supplements (ONS) and nasal feeding nutrition (NF), including nasogastric tube nutrition (NGT) and naso-jejunal tube nutrition (NJT), on nutritional support for elderly hospitalized patients (≥ 80 years old). Methods　One hundred and eight elderly patients admitted to the Geriatric Department, Respiratory Department, Emergency Department, Gastrointestinal Surgery Departmet, Hepatobiliary Surgery Departmet, Pepartment Neurosurgery Department, and Critical Medicine Department of Lianyungang Hospital, Jiangsu University from September 2018 to December 2021 were selected. The support of enteral nutrition (EN) was analyzed. According to the EN support methods, they were divided into an ONS group (50 cases, including 31 males and 19 females) and an NF group (58 cases, including 38 males and 20 females). The NF group included 40 cases in the NGT group and 18 cases in NJT group. The patients were 80-98 years old. The average age was 85.7 in the ONS group and 84.9 in the NF group. The EN support time was more than 14 days, and the intake of the amount of calories and nitrogen was the same. The serum prealbumin (PA), total protein (TP), albumin (ALB), hemoglobin (Hb), and red blood cell (RBC) counts, as well as inflammatory factors C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and tumor necrosis factor α (TNF-α)] and the immune indicators CD3+, CD4+, CD8+, immunoglobulin (Ig) G, IgA, and IgM], were compared between the ONS group, the NGT group, and the NJT group. The SPSS 18.0 software was used for the data analysis, t test and F test for the measurement data, and χ² test for the counting data. If P≤0.05, there is a statistical difference. Results　There was no statistical difference in protein nutritional status between the three groups before EN support (P>0.05). After EN support, the levels of serum PA, TP, and ALB significantly increased (all P<0.05), the levels of CRP, IL-6, PCT, and TNF-α obviously decreased (all P<0.05), but the Hb and RBC count did not increase significantly (all P>0.05) in all the 3 groups. The IgG, IgA, IgM, CD3+, and CD4+ of the ONS group were higher than those of the NGT group and the NJT group at the same time points (all P<0.05), and the CD8+ was lower than those of the NGT group and the NJT group (both P<0.05). Fourteen days after the treatment, the incidences of diarrhea (6%, 3/50), reflux (8%, 4/50), and gastrointestinal bleeding (2%, 1/50) in the ONS group were statistically different from those in the NGT group and the NJT group (all P<0.05); and the incidences of vomiting (4%, 2/50) and recurrent pulmonary infection (4%, 2/50) in the ONS group were statistically different from those in the NGT group at the same time points (both P < 0.05), but were not statistically different from those in the NJT group at the same time points (both P > 0.05). Conclusions　In the EN support of elderly patients (≥ 80 years old), ONS and NF supports can effectively improve their protein nutritional status, and ONS has more significant effect. EN for elderly patients can significantly alleviate the disease severity, improve the levels of inflammatory mediators and oxidative stress, and reduce the incidence of complications, and has definite effect.