间歇性鼻饲技术对重度脑外伤伴吞咽障碍患者的疗效研究

吴超; 卢爱兰; 陈巧鸽

doi:10.16766/j.cnki.issn.1674-4152.002290

间歇性鼻饲技术对重度脑外伤伴吞咽障碍患者的疗效研究

doi: 10.16766/j.cnki.issn.1674-4152.002290

浙江大学医学院附属金华医院康复科，浙江金华 321000

基金项目:

浙江省基础公益研究计划项目 LY20H070011

详细信息

通讯作者:
吴超，E-mail: wuchaochao349@163.com

中图分类号: R651.15 R49
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- 被引次数: 0
出版历程
- 收稿日期: 2020-12-25
- 网络出版日期: 2022-03-03

Effect of intermittent nasogastric feeding on patients with severe traumatic brain injury and dysphagia

Department of Rehabilitation, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, China

摘要

摘要: 目的观察间歇性鼻饲技术对重度脑外伤伴吞咽障碍患者的临床疗效。方法 2017年4月—2020年3月在浙江大学医学院附属金华医院接受治疗的70例重度脑外伤伴吞咽障碍患者并按照随机数字表法分为治疗组(35例)和对照组(35例)。对照组应用持续鼻胃管留置进行营养支持治疗，治疗组应用间歇性鼻饲技术进行营养支持治疗。观察治疗前后2组吞咽功能、营养状况、睡眠质量改善情况，并比较并发症发生情况和临床疗效。结果治疗后治疗组洼田饮水试验结果明显优于对照组(Z=-2.684，P＜0.05)，体重指数及血清白蛋白(ALB)、前清蛋白(PAB)、血红蛋白(Hb)水平均明显高于对照组(t=3.431、3.530、3.143、3.155，均P＜0.05)，匹兹堡睡眠质量指数(PSQI)评分低于对照组(t=7.930，P＜0.05)。治疗组肺部感染和腹胀并发症发生率均低于对照组(χ²=6.437、4.590，均P＜0.05)。治疗组总有效率[97.14%(34/35)]优于对照组[77.14%(27/35)，χ²=4.590，P＜0.05]。结论对重度脑外伤伴吞咽障碍患者应用间歇性鼻饲技术能明显改善吞咽功能及营养状况，提高睡眠质量，并发症发生率低，效果显著。
- 间歇性鼻饲技术 /
- 重度脑外伤伴吞咽障碍 /
- 肺部感染 /
- 睡眠质量 /
- 营养状态
Abstract: Objective To observe the clinical effect of intermittent nasogastric feeding on patients with severe brain injury and dysphagia. Methods Total 70 patients with severe traumatic brain injury with dysphagia in the Affiliated Jinhua Hospital, Zhejiang University School of Medicine from April 2017 to March 2020 were randomly divided into treatment (35 cases) and control (35 cases) groups according to the random-number table. The control group was treated with continuous nasogastric tube indwelling for nutritional support, whereas the treatment group was treated with intermittent nasogastric feeding technology. Improvements in the swallowing function, nutritional status, and sleep quality of the two groups before and after treatment were observed, and the clinical efficacy and complications during treatment were compared. Results After treatment, the result of water-drinking test in the treatment group was significantly better than that in the control group (Z=-2.684, P < 0.05), body mass index, serum albumin, prealbumin, and haemoglobin levels in the treatment group were significantly higher than those in the control group (t=3.431, 3.530, 3.143, 3.155, all P < 0.05). The Pittsburgh sleep quality index (PSQI) score in the treatment group was lower than that of the control group (t=7.930, P < 0.05). The incidence of pulmonary infection and abdominal distension complications in the treatment group were lower than those in the control group (χ²=6.437, 4.590, both P < 0.05). The total effective rate was 97.14% (34/35) in the treatment group, which was much better than the 77.14% (27/35) in the control group (χ²=4.590, P < 0.05). Conclusion Intermittent nasogastric feeding for patients with severe traumatic brain injury and dysphagia can significantly improve the swallowing function and nutritional status and improve sleep quality. The incidence of complications is low, and the effect is significant.
- Intermittent nasal feeding technology /
- Severe brain injury with dysphagia /
- Pulmonary infection /
- Sleep quality /
- Nutritional status

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表 1 2组重度脑外伤伴吞咽障碍患者治疗前后吞咽功能比较[例(%)]

组别	例数	时间	1级	2级	3级	4级	5级
对照组	35	治疗前	0	1(2.86)	12(34.29)	17(48.57)	5(14.29)
		治疗后	5(14.29)	8(22.86)	14(40.00)	5(14.29)	3(8.57)
治疗组	35	治疗前	0	0	8(22.86)	20(57.14)	7(20.00)
		治疗后	10(28.57)	15(42.86)	7(20.00)	2(5.71)	1(2.86)

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表 2 2组重度脑外伤伴吞咽障碍患者治疗前后营养状况比较(x±s)

组别	例数	体重指数		ALB(g/L)		PAB(mg/L)		Hb(g/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	35	19.24±2.36	21.33±2.57^a	26.87±4.20	31.02±4.89^a	159.87±12.46	174.68±15.21^a	110.45±11.24	123.67±15.56^a
治疗组	35	19.44±2.27	23.56±2.86^a	26.55±4.42	35.24±5.11^a	158.11±13.01	186.74±16.85^a	108.69±11.11	135.58±16.02^a
t值		0.361	3.431	0.310	3.530	0.578	3.143	0.659	3.155
P值		0.719	0.001	0.757	0.001	0.565	0.002	0.512	0.002
注：与同组治疗前比较，^aP＜0.05。

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表 3 2组重度脑外伤伴吞咽障碍患者治疗前后睡眠质量比较(x±s，分)

组别	例数	PSQI评分		t值	P值
组别	例数	治疗前	治疗后	t值	P值
对照组	35	13.46±2.25	8.12±1.51	11.659	< 0.001
治疗组	35	13.21±2.32	5.67±1.03	17.573	< 0.001
t值		0.458	7.930
P值		0.649	< 0.001

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表 4 2组重度脑外伤伴吞咽障碍患者治疗期间并发症发生情况比较[例(%)]

组别	例数	肺部感染	消化道出血	胃食管反流	腹胀	鼻、咽、食管黏膜溃疡
对照组	35	10(28.57)	3(8.57)	5(14.29)	8(22.86)	7(20.00)
治疗组	35	2(5.71)	0	1(2.86)	1(2.86)	1(2.86)
χ²值		6.437	0.239	1.641	4.590	3.528
P值		0.011	0.120	0.200	0.032	0.060

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表 5 2组重度脑外伤伴吞咽障碍患者临床疗效比较[例(%)]

组别	例数	治愈	显效	有效	无效	总有效
对照组	35	5(14.29)	10(28.57)	12(34.29)	8(22.86)	27(77.14)
治疗组	35	10(28.57)	19(54.29)	5(14.29)	1(2.86)	34(97.14)
注：2组总有效率比较，χ²=4.590，P=0.032。

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