长期昏迷患者不同营养支持的临床应用价值探讨

Clinical Value of Different Nutritional Support in Patients with Long-Term Coma

摘要: 目的：比较在昏迷患者的营养支持方式中，经皮内镜下胃/空肠造瘘术和鼻饲对患者全身营养状况的改善情况及肺部感染、消化道出血的发生率。方法：对77例长期昏迷患者分造瘘组37例和对照组40例，在常规治疗的基础上，造瘘组行胃肠造瘘术进行肠内营养支持，对照组进行鼻饲，观察记录治疗前后的血常规、生化等及出现便血时间、肺部感染时间、以及抗生素使用种类与时间。结果：在造瘘组37例患者中，6例在后期治疗观察中出现大便隐血阳性，占16.22%；在鼻饲组有16例患者出现隐血，占40.00%，卡方检验显示，P = 0.021 < 0.05，有统计学意义。造瘘组有16例患者出现了肺部感染，占43.24%；鼻饲组有19例患者出现了肺部感染，占47.50%，卡方检验显示，P = 0.708 > 0.05，无统计学意义。造瘘组有27例患者在治疗后白蛋白较前升高，占73%，10例白蛋白较前下降，占27%；鼻饲组有15例患者白蛋白较前上升，占37.50%，24例白蛋白较前下降，占60%，1例无变化。卡方检验显示，P = 0.006 < 0.05，有统计学意义。结论：经皮内镜下胃/空肠造瘘技术相比鼻饲能显著改善患者的全身营养状况，降低消化道出血的发生率；但肺部感染的发生率两组无统计学意义。

Abstract: Objective: To compare the effects of percutaneous endoscopic gastrojejunostomy and nasal feeding on the nutritional status of comatose patients and the incidence of pulmonary infection and gastrointestinal bleeding in the different nutritional support methods. Methods: 77 patients with long-term coma were divided into PEG group (37 cases) and control group (40 cases). On the basis of routine treatment, gastrointestinal fistula was performed in gastrointestinal fistula group for enteral nutrition support, while nasal feeding was performed in control group. Blood routine, bi-ochemistry, time of stool bleeding, time of pulmonary infection, and type and time of antibiotic use before and after treatment were observed and recorded. Result: Among 37 patients in PEG group, 6 patients had positive occult blood in stool in the late treatment observation, accounting for 16.22%; 16 patients in nasal feeding group had occult blood, accounting for 40.00%. Chi-square test showed that P = 0.021 < 0.05, with statistical significance. There were 16 patients with pulmonary infection in PEG group (43.24%) and 19 patients with pulmonary infection in nasal feeding group (47.50%). Chi-square test showed that there was no statistical significance (P = 0.708 > 0.05). In the PEG group, albumin increased in 27 cases (73%) and decreased in 10 cases (27%). In the nasal feeding group, albumin increased in 15 cases (37.50%); albumin decreased in 24 cases (60%) and remained unchanged in 1 case. Chi-square test showed that P = 0.006 < 0.05, with statistical significance. Conclusion: Compared with nasal feeding, PEG can significantly improve the nutritional status of patients and reduce the incidence of digestive tract hemorrhage, but the incidence of pulmonary infection has no statistical significance between the two groups.