脑卒中伴有吞咽困难患者营养支持治疗的临床研究(1)
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【摘要】目的 评估不同营养支持方式对营养不良患者各项营养指标、治疗效果及并发症的影响。方法 113例脑卒中伴有吞咽困难患者，分为序贯性肠内营养支持治疗组和匀浆膳组。分别记录入院时和营养支持治疗21d 营养指标，并发症发生率及临床疗效变化。结果 治疗后序贯性肠内营养治疗组各项营养指标均高于匀浆膳组，感染并发症发生率低于匀浆膳组，临床疗效优于匀浆膳组。结论 脑卒中伴有吞咽困难的患者给予早期、合理的肠内营养支持治疗，能够改善患者的营养指标，降低并发症的发生率，促进神经功能恢复，提高临床疗效。
【关键词】脑卒中 吞咽困难 营养不良 肠内营养 营养支持 并发症
中图分类号：R473.74 文献标识码：A 文章编号：1005-0515(2012)3-034-03
The clinical research of nutritional support treatment
on stroke patients with dysphagia
ZHANG Yanqiu XUE Rong CHENG Yan
【Abstract】Objective This study further clear the impact of different nutritional support of malnutrition indicators of nutrition, treatment and complications.Methods 113 cases of stroke patients with dysphagia hospitalized in the stroke unit of neurology department in our hospital, were randomly divided into two groups, sequential enteral nutrition therapy group and homogenized feeding group. Two groups of patients on admission and nutritional support for 21 d were recorded TSF, AMC, Hb, ALB, PA, at the same time observe the infection rate of complications and Clinical (NIHSS Score) changes .Results After the sequential treatment of enteral nutrition therapy group nutrition indicators were higher than the homogenized group meal, infection complication rate lower than the homogenized group meal, clinical efficacier than homogenate feeding group, and the differences were statistically significant.Conclusion With the stroke of malnutrition in patients with conventional treatment for early stage at the same time, reasonable enteral nutrition therapy, patients can improve the nutritional indicators, reduce the incidence of infection complications, promote the neurological recovery, improve the clinical efficacy.
【Key Words】stroke dysphagia dystrophy enteral nutrition nutritional support complication
1 对象和方法
1.1 资料来源 2007年9月至2010年3月天津医科大学总医院神经内科卒中单元连续住院的脑卒中患者113例，男78例，女35例，脑梗死患者88例，脑出血25例，年龄67~85岁。所有病例均符合1995年全国脑血管病学术会议制定的诊断标准，并经头颅CT或MRI证实。所有患者均经吞咽功能评估，伴有吞咽困难(窪田氏饮水试验≥3级)或意识障碍，不能正常进食。所有患者均无严重心、肝、肾疾病、内分泌及代谢疾病、肿瘤及严重营养不良，病后生存期<3周者除外。
1.2 营养支持治疗方法 将113例患者随机分为2 组，序惯性肠内营养治疗组和匀浆膳组。序惯性肠内营养治疗组：于入院后72h内留置胃管，首先给予短肽型肠内营养剂百普素125g/d(荷兰纽迪希亚公司)，3d后换用整蛋白型肠内营养剂能全力500mL/d(荷兰纽迪希亚公司)，采用重力滴注65mL/h，2d后加至1000~1500mL/d，80~100mL/h，输液泵控制滴速，加热器使营养液温度维持在30℃~40℃。匀浆膳组：于入院后72h内留置胃管，由家属自行管理饮食，基本饮食内容包括牛奶、豆浆、肉汤、米汤、蔬菜汁、鸡蛋羹等或是由以上内容自行混制而成的匀浆膳 ......
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