肠内营养制剂恒温与加温输注对重症脑损伤患者胃肠道并发症的影响

doi:10.3969/j.issn.1672-1756.2017.07.027

肠内营养制剂恒温与加温输注对重症脑损伤患者胃肠道并发症的影响

刘芳杨倩倩孙蕊高岚苗凤茹张晓梅霍春暖邓秋霞王宇娇

首都医科大学宣武医院神经内科ICU，100053 北京市（刘芳，孙蕊）；College of Science,Health and Engineering, La Trobe University, Australia（杨倩倩）；吉林省医科大学第一医院神经内科ICU（高岚，邓秋霞，王宇娇）；航天中心医院神经内科（苗凤茹）；南方医科大学南方医院神经内科(张晓梅）；中国人民解放军总医院神经内科ICU（霍春暖）

出版日期:2017-07-25 发布日期:2017-07-25

The effects of enteral nutrition preparations in thermoneutral temperature infusion and heating infusion on gastrointestinal complications of patients with severe brain injury

Online:2017-07-25 Published:2017-07-25

摘要/Abstract

摘要： 目的：通过对重症脑损伤患者肠内营养制剂进行恒温与加温输注，观察胃肠道并发症的发生情况，为患者输注肠内营养制剂是否加温提供更好的临床依据。方法:采用前瞻性随机对照研究，为防止区域性差异分别选择中国华北、东北、华南等地的5家医院，经鼻胃管给予营养支持的患者234例，入院后按随机数字表将患者分恒温组与加温组，其中恒温组117例，加温组117例，加温组使用带有加热功能的肠内营养泵，温度设定在37～40℃。恒温组ICU病室内温度保持在（24.0±1.5)℃，观察两组患者给予营养支持7日内胃肠道并发症发生情况。结果:两组患者胃肠道并发症中便秘发生最多为62例次（26.5%），加温组21例次（17.9%），恒温组41例次（35.0%），两组比较具有统计学差异（P<0.05）；胃潴留共发生为51例次（21.8%），加温组发生19例次（16.2%），恒温组32例次（27.4%），两组比较具有统计学差异（P<0.05）；腹泻共发生50例次（21.4%），其中加温组41例次（35.0%），恒温组9例次（7.7%），两组比较具有统计学差异（P<0.05)；腹胀6例次（2.6%），呕吐2例次（0.9%），消化道出血0例次，两组均无统计学差异（P>0.05）。结论：重症脑损伤患者实施肠内营养支持过程中，可根据患者的胃肠道并发症的不同，采取针对性的护理干预，以减少胃肠道并发症发生。

Abstract: Objective: To explore the incidences of gastrointestinal complications of patients with severe brain injury using the enteral nutrition support, and compare the incidences of gastrointestinal complications between the patients with enteral nutrition preparations in thermoneutral temperature infusion and heating infusion. Methods: Totally 234 patients with enteral nutrition support were selected from five hospitals in China using group sampling method. The subjects were randomly divided into thermoneutral temperature infusion group and heating infusion group. The thermoneutral group remain the ICU room temperature at (24.0±1.5). The heating group using enteral feeding pump with heating temperature between 37℃and 40. Results: The main complications of the subjects were constipation 62 cases (26.5%), gastric retention 51 cases (21.8%), diarrhea 50 cases (21.4%), abdominal distention 6 cases (2.6%), vomiting 2 cases (0.9%). The incidences of constipation and gastric retention in the thermoneutral groupwere significantly higher than the heating group (χ2=8.777, P<0.05) (χ2=4.237, P<0.05) respectively. The incidence of diarrhea in the thermoneutral group was significantly lower than the heating group (χ2=26.045, P<0.05). Conclusions: The gastrointestinal complications are the major issues in the process of the enteral nutrition support in patients with severe brain injury. Nursing intervention to prevent and reduce the gastrointestinal complications should be emphasized.

刘芳杨倩倩孙蕊高岚苗凤茹张晓梅霍春暖邓秋霞王宇娇. 肠内营养制剂恒温与加温输注对重症脑损伤患者胃肠道并发症的影响[J]. , 2017, 17(7): 971-976.