急性出血性脑卒中患者序贯式肠内营养治疗的临床研究

目的探讨早期序贯式肠内营养（EN）支持对急性出血性脑卒中患者的营养状态、并发症发生率及预后的影响。方法将内蒙古医科大学附属医院神经外科2017年9月—2019年7月收治的69例急性出血性脑卒中的患者随机分成两组，并组间相互比较。实验组35例患者接受EN制剂逐渐过渡至整蛋白的序贯式EN治疗，对照组34例患者全程采用整蛋白型EN制剂，依据内蒙古医科大学附属医院神经外科自行制定的营养技术路线实施治疗方案。观察两组患者日均获得EN目标量的时间、所需联合肠外营养（PN）疗法的比率、低清蛋白血症发生率、喂食后的并发症以及平均入住神经外科重症监护病房NICU天数等指标。结果两组患者均能达到EN目标的治疗效果。治疗后第7、第14天实验组上臂肌围（MAMC）和血清前白蛋白（PAB）浓度均高于对照组（P＜0.05)，感染发生率小于对照组（P＜0.05)，实验组预后与对照组无显著差异（P＞0.05)。两组间与其他喂养方式相关的并发症和平均入住NICU时间无统计学差异（P＞0.05）。结论序贯式EN可显著提高急性出血性脑卒中患者的全身营养状况，改善机体免疫功能，明显降低其他合并症的风险，缩短患者住院时间，但对预后无显著影响（P＞0.05）。序贯式EN较整蛋白EN治疗效果更好，有一定临床应用价值。

Objective To explore the effects of early sequential enteral nutrition(EN) support on the nutritional status, complication rate and prognosis of acute hemorrhagic stroke patients. Methods 69 patients with acute hemorrhagic stroke admitted to Department of Neurosurgery, the Affiliated Hospital of Inner Mongolia Medical University from September 2017 to July 2019 were randomly divided into two groups.35 patients in the experimental group received sequential EN therapy with gradual transition from EN preparation to whole protein, while 34 patients in the control group were treated with whole protein-based EN preparation throughout the whole course of treatment.The treatment program was implemented according to the nutritional technology route developed by Department of Neurosurgery, the Affiliated Hospital of Inner Mongolia Medical University. The average daily time to obtain the target amount of EN, the rate of combined parenteral nutrition(PN) therapy, the incidence of hypoalbuminemia, the complications after feeding, and the average number of days in the neurosurgical intensive care unit(NICU) in the two groups were observed. Results Both groups were able to achieve the EN treatment target. The mid-arm muscle circumference(MAMC) and serum prealbumin(PAB) concentration of the experimental group were higher than that of the control group on the 7th and 14th day after treatment(P<0.05), and the incidence of infections was less than that of the control group(P<0.05), and the prognosis of the experimental group was not significantly different from that of the control group(P>0.05 ). There was no statistically significant difference in complications related to other feeding modalities and mean length of stay in the NICU between the two groups(P>0.05). Conclusions Sequential EN can significantly improve the systemic nutritional status of patients with acute hemorrhagic stroke, improve the body’s immune function, significantly reduce the risk of other comorbidities, and shorten the length of hospitalization of the patients, but it has no significant effect on the prognosis(P>0.05). Sequential EN has a better therapeutic effect than whole protein EN and has some clinical application value.