果胶加间断输注肠内营养剂在脑卒中伴吞咽障碍患者的应用

doi:10.16460/j.issn1008-9969.2019.14.055

摘要/Abstract

摘要： 目的探讨果胶加间断输注肠内营养制剂对脑卒中伴吞咽障碍患者的早期肠内营养的耐受性及热量达标率影响。方法选取我院2017年10月—2018年11月入住神经内科且需要留置胃管行肠内营养的卒中伴吞咽障碍患者。按照随机对照的原则分为观察组和对照组各64例。观察组采用鼻饲蕊福平果胶加间断输注肠内营养制剂,对照组给予肠内营养制剂持续输注。比较2组患者1周内肠内营养不耐受发生率（包括呕吐、腹泻、便秘、腹胀、误吸、胃潴留的发生率差异,比较肠内营养实施第3天、第7天2组患者热量达标率差异。结果观察组肠内营养期间呕吐、腹泻、误吸、腹胀的发生率低于对照组（P<0.05,但在胃潴留、便秘的发生率与对照组差异无统计学意义（P>0.05。干预第3天、第7天,观察组的肠内营养热量达标率高于对照组（P<0.05。结论给予果胶加间断输注肠内营养制剂与连续输注肠内营养制剂相比,可以降低脑卒中患者早期肠内营养过程中腹泻、误吸、腹胀、呕吐的发生率,同时提高患者早期热量达标率。

关键词: 脑卒中, 吞咽障碍, 肠内营养, 果胶, 体内半固化

Abstract: Objective To investigate the effects of pectin and continuous enteral nutrition (EN on the tolerance of early EN and the rate of meeting EN needs in patients with stroke and dysphagia. Methods The patients with stroke and dysphagia admitted to the Department of Neurology from October 2017 to November 2018 and required to indwell gastric tube for enteral nutrition were selected and divided into observation group and control group, with 64 patients in each group. The in vivo semi-curing infusion method of Ruifuping pectin and enteral nutrition was used in the observation group, and traditional continuous EN infusion method in the control group. The intolerance of EN within one week was analyzed, including the incidences of vomiting, diarrhea, constipation, abdominal distension, aspiration and gastric retention. The rate of meeting EN needs on the third and seventh day were measured in the two groups. Results The incidences of vomiting, diarrhea, abdominal distension and aspiration in the early stage of EN in the observation group were lower than those in the control group (P<0.05, and the differences were statistically significant, while there was no statistical difference between the incidence of gastric retention and constipation (P>0.05. The rate of meeting EN needs on the third day and seventh day in the observation group was higher than that in the control group, and the difference was statistically significant (P<0.05. Conclusion Compared with traditional infusion methods, in vivo semi-curing infusion method of pectin and EN can reduce the incidences of diarrhea, aspiration, abdominal distension and vomiting during early EN and improve the rate of meeting EN needs, which is worthy of clinical promotion.

Key words: stroke, dysphagia, enteral nutrition, pectin, in vivo semi-curing

中图分类号:

R473.74

臧丽丽, 时敏秀, 张旋, 唐亚男. 果胶加间断输注肠内营养剂在脑卒中伴吞咽障碍患者的应用[J]. 护理学报, 2019, 26(14): 55-58.

ZANG Li-li, SHI Min-xiu, ZHANG Xuan, TANG Ya-nan. Effect of Pectin and Continuous Infusion of Enteral Nutrition in Stroke Patients with Dysphagia[J]. Journal of Nursing, 2019, 26(14): 55-58.

参考文献

[1]Kozeniecki M, Fritzshall R.Enteral Nutrition for Adults in the Hospital Setting[J]. Nutr Clin Pract,2015,30(5):634-651.DOI:10.1177/0884533615594012.
[2]Mentec H, Dupont H, Bocchetti M, et al.Upper Digestive Intolerance during Enteral Nutrition in Critically ill Patients:Frequency, Risk Factors, and Complications[J]. Crit Care Med,2001,29(10):1955-1961.
[3]Ukleja A.Altered GI Motility in Critically Ill Patients:Current Understanding of Pathophysiology,Clinical Impact,and Diag- nostie Approach[J].Nutr Clin Pract,2010,25(1):16-25.
[4]刘芳,魏娜,阮征,等. 小肠喂养管在重症脑损伤合并胃潴留患者中的应用效果[J]. 解放军护理杂志,2013, 30(23):7274.DOI:10.3969/j.issn.1008-9993.2013.23.025.
[5]Ramsey D, Smithard D, Kalra L.Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients[J].Stroke,2003,34(5):1252-1257.
[6]Shimoyama Y, Kusano M, Kawamura O, et al.High-viscosity Liquid Meal Accerates Gastric Emptying[J].Neurogastroenterol Motil, 2007,19:879-886.DOI:10.1111/j.1365-2982.2007.00972.x.
[7]吴群强,焦卉朵,廖春华.可溶性膳食纤维联合益生菌在老年患者肠内营养相关性腹泻中的应用[J].贵州医药,2019,43(3):432-434.
[8]祝剑虹,周梦良,孙海晨,等.半固化经幽门肠内营养在神经外科危重症患者的应用[J].江苏医药,2019,45(3):235-238.
[9]中华医学会肠外肠内营养学分会神经疾病营养支持学组.神经系统疾病肠内营养支持操作规范共识(2011版[J].中华神经科杂志,2011,44(11):787-791.
[10]郭桂芳,姚兰.外科护理学[M].北京:北京医科大学出版社,2000:28.
[11]Tan M, Zhu J C, Yin H H.Enteral Nutrition in Patients with Severe Traumatic Brain-injury:Reasons for Intolerance and Medical Management[J]. Br J Neurosurg,2011,25(1):2-8.
[12]张丹羽,王卫华,谢丽.亚甲蓝在机械通气患者胃反流误吸监测中的应用[J].护理学杂志,2015,30(4):14-16.
[13]姜婷婷,王新颖. 膳食纤维改善重症患者腹泻的研究进展[J].中华危重症医学杂志(电子版),2016,9(2):138-141.
[14]杨纲,伍晓汀.膳食纤维在危重病人肠内营养中的应用[J]. 华西医学,2004,19(3):503-505.
[15]杨芳. 益生菌联合肠内营养在重症患者疾病治疗中的应用[J].临床与病理杂志,2018,38(12):2702-2706.
[16]Lim Y H, Kim D H, Lee M Y, et al.BoweI Dysfunction and Colon Transit Time in Brain-injured Patients[J]. Ann Rehabil Med,2012, 36(3):371-378.DOI:10.5535/arm.2012.36.3.371.
[17]夏萌,张华,杨敏京.不同热量营养支持对伴吞咽困难急性卒中患者的作用[J].中国脑血管病杂志, 2010,7(3):124-128.
[18]刘朝晖,苏磊,廖银光,等.危重症病人营养支持与静息代谢目标值分析[J].肠外与肠内营养,2014,21(4):198-200.

相关文章 15

[1]	谢延真, 李壮苗, 张佳宇, 纪秋露, 吴宇欣. 灸法治疗脑卒中后偏瘫的文献计量学分析[J]. 护理学报, 2020, 27(11): 16-20.
[2]	丁春戈, 林蓓蕾, 张振香. 社区医务人员对居家脑卒中患者分级护理认知的质性研究[J]. 护理学报, 2019, 26(4): 5-9.
[3]	达志, 季学丽, 张丽. 急性缺血性脑卒中绿色通道信息化建设与应用[J]. 护理学报, 2019, 26(14): 19-21.
[4]	胡恩华, 庞志强, 尹炜, 聂涛, 黄海燕. 1例重症肺炎产妇行体外膜肺氧合联合俯卧位通气治疗的护理[J]. 护理学报, 2019, 26(11): 68-70.
[5]	周瑜,米元元. ICU患者误吸研究进展[J]. 护理学报, 2018, 25(9): 39-43.
[6]	张敏,王清,李红丽. 急性脑卒中患者心理弹性现况及其影响因素研究[J]. 护理学报, 2018, 25(9): 75-78.
[7]	邓小燕,马嫣,段雪兰,蒋涛,安云霞. 提高脑卒中患者健康教育质量的品管圈实践[J]. 护理学报, 2018, 25(7): 70-74.
[8]	刘幼华,郭红,杨倮,赵丹,琚慧,王海妍. 基于Web of Science的国际脑卒中护理研究可视化分析[J]. 护理学报, 2018, 25(5): 6-11.
[9]	李真, 曹晶, 李佳倩, 吴欣娟. 卒中后谵妄危险因素的Meta分析[J]. 护理学报, 2018, 25(22): 38-43.
[10]	赵诗雨, 柯卉, 李梦圆, 熊璨, 喻姣花. 肠内营养补充剂防治压疮效果的系统评价[J]. 护理学报, 2018, 25(20): 24-30.
[11]	王军, 关欣, 马春梅, 王征. 综合认知干预训练在缺血性脑卒中术后血管性认知障碍患者中的应用观察[J]. 护理学报, 2018, 25(20): 50-53.
[12]	赵振华,陈璐,王芳. 121例脑卒中患者出院后2周自我效能现状及影响因素分析[J]. 护理学报, 2018, 25(2): 54-57.
[13]	李薇薇,何小俊. 语言康复素材在脑卒中失语患者中的应用研究进展[J]. 护理学报, 2018, 25(15): 21-25.
[14]	邓娟,谢红珍. 移动互联网与机器人技术在脑卒中患者管理中的应用现状[J]. 护理学报, 2018, 25(14): 29-32.
[15]	彭洁婧,黄璜. 改良流质鼻饲装置的研制[J]. 护理学报, 2018, 25(10): 78-.

Metrics

Viewed

Full text

Abstract

Cited

Shared