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目的研究早期肠内营养支持对70岁以上急性脑卒中(ABS)伴吞咽困难患者氮平衡及预后的影响,为提高患者营养水平,降低并发症发生风险提供科学依据。方法选取天津市职业病防治院2014年11月至2016年3月收治的ABS患者87例为研究对象,随机将患者分为肠内营养支持组(43例)和对照组(44例)。对照组患者入院后72 h内留置鼻胃管并给予流质饮食,肠内营养支持组给予肠内营养支持。观察两组患者治疗期间氮平衡情况、血浆白蛋白水平、美国国立卫生研究院卒中量表(NIHSS)评分及并发症发生率。用STATA 4.0软件进行t检验和χ2检验。结果治疗第1~4周肠内营养支持组氮平衡分别为(-4.4±1.2)、(-3.6±1.3)、(-2.9±1.4)和(-2.1±1.0)g/d,对照组分别为(-8.6±3.2)、(-7.2±2.1)、(-6.4±1.4)和(-5.9±1.0)g/d,肠内营养支持组患者氮平衡均明显高于对照组,差异均有统计学意义(P<0.05)。肠内营养支持组治疗2、3、4周后,血浆白蛋白水平分别为(34.2±2.1)、(35.1±1.9)和(36.2±1.7)g/L,明显高于对照组[分别为(28.6±1.9)、(27.7±2.1)和(28.4±1.8)g/L],差异均有统计学意义(t值分别为13.05、18.16和20.77,P<0.05)。治疗前及治疗1周时,对照组血浆白蛋白分别为(37.2±2.4)和(35.3±2.0)g/L,肠内营养支持组分别为(38.0±2.2)和(35.1±2.4)g/L,差异均无统计学意义(t值分别为1.21、0.42,P>0.05)。肠内营养支持组和对照组治疗前NIHSS评分分别为(14.8±3.1)、(15.1±3.3)分,差异无统计学意义(t=0.44,P>0.05);治疗后,肠内营养支持组NIHSS评分为(6.1±2.3)分,明显低于对照组[(8.3±2.4)分],差异有统计学意义(t=4.36,P<0.05)。肠内营养支持组住院治疗期间误吸、肺感染、腹泻、腹胀及消化道出血发生率明显低于对照组,差异均有统计学意义(P<0.05)。结论早期肠内营养能够快速纠正老年ABS患者负氮平衡,提高营养水平,降低相关并发症发生风险。
Objective To study the effects of early enteral nutrition support on nitrogen balance and prognosis in patients with acute stroke (ABS) and dysphagia over 70 years old, and to provide scientific basis for improving patients’ nutritional status and reducing the risk of complications. Methods Totally 87 patients with ABS who were admitted to Tianjin Occupational Disease Prevention and Treatment Hospital from November 2014 to March 2016 were randomly divided into enteral nutrition support group (43 cases) and control group (44 cases). Patients in the control group were given nasogastric tube within 72 h after admission and were given liquid diet. Enteral nutrition support group was given enteral nutrition support. Nitrogen balance, plasma albumin, NIHSS score, and complication rates were observed during treatment in both groups. The t test and the χ2 test were performed using STATA 4.0 software. Results The nitrogen balance of enteral nutrition support group was (-4.4 ± 1.2), (-3.6 ± 1.3), (-2.9 ± 1.4) and (-2.1 ± 1.0) g / d respectively in the first week to the fourth week of treatment, Were (-8.6 ± 3.2), (-7.2 ± 2.1), (-6.4 ± 1.4) and (-5.9 ± 1.0) g / d, respectively, and the nitrogen balance in enteral nutrition support group was significantly higher than that in control group Statistical significance (P <0.05). Plasma albumin levels in enteral nutrition support group were (34.2 ± 2.1), (35.1 ± 1.9) and (36.2 ± 1.7) g / L after 2,3,4 weeks of treatment, respectively, which were significantly higher than those in control group [ 28.6 ± 1.9), (27.7 ± 2.1) and (28.4 ± 1.8) g / L respectively. The differences were statistically significant (t = 13.05, 18.16 and 20.77 respectively, P <0.05). The levels of plasma albumin in the control group were (37.2 ± 2.4) and (35.3 ± 2.0) g / L before treatment and one week after treatment, respectively, and those in the enteral nutrition group were (38.0 ± 2.2) and (35.1 ± 2.4) g / L, the differences were not statistically significant (t values were 1.21,0.42, P> 0.05). The NIHSS scores of enteral nutrition support group and control group before treatment were (14.8 ± 3.1) and (15.1 ± 3.3) points respectively, with no significant difference (t = 0.44, P> 0.05). After enteral nutrition support group and control group, The NIHSS score was (6.1 ± 2.3) points, which was significantly lower than that of the control group [(8.3 ± 2.4) points], the difference was statistically significant (t = 4.36, P <0.05). The incidence of aspiration, pulmonary infection, diarrhea, abdominal distension and gastrointestinal bleeding during enteral nutrition support group was significantly lower than that of the control group during hospitalization, with significant differences (P <0.05). Conclusions Early enteral nutrition can quickly correct the negative nitrogen balance in elderly patients with ABS, increase the nutrition level and reduce the risk of related complications.