摘要
目的:探讨经皮内镜下胃造口术(PEG)对重度颅脑损伤并发吞咽障碍病人营养支持和控制肺部感染的临床意义。方法:将60例病人随机分为PEG管饲组和鼻胃管(NGT)管饲组,每组各30例。管饲4周后,比较两种EN方法对病人体重指数(BMI)、血清清蛋白(ALB)、前清蛋白(PA)、血红蛋白(Hb)水平和非瘫痪侧肱三头肌皮褶厚度(SFT)的影响,并对观察期间肺部感染病人进行胃液和痰液细菌学监测,探讨管饲方法对肺部感染的影响。结果:管饲4周时,与NGT组比,PEG组病人BMI、血清ALB、PA、Hb水平和SFT等指标有明显增加(P<0.05);肺部感染发生率明显减少(P<0.05);肺部感染病人胃液和痰液标本细菌培养阳性率明显降低(P<0.01)。NGT组病人胃液中与肺部病原菌种类的一致性和构成比类似,PEG组则未见此现象。结论:经皮内镜下胃造口管饲较鼻胃管管饲能更好地改善重度颅脑损伤并发吞咽障碍病人的营养状况,减少肺部感染的发生率。
Objective： To investigate prospectively the clinical curative effect of percutaneous endoscopic gastrostomy （PEG） in improving nutrition and decreasing aspiration pneumonia in patients with severe traumatic brain injury and dysphagia. Methods： 60 patients were randomly divided into two groups,30 in PEG group, and the others in NGT group . After 4 weeks of enteral feeding,nutrition indices such as body mass index（ BMI）, serum albumin level（ALB） , serum prealbumin level（PA） , hemoglobin level（Hb） and the skinfold thickness（SFY） of triceps of nonparalytic side were compared between the two feeding methods. The pathogenic bacterium in sputum and gastric fluid in patients with acquired pulmonary infections were examined. Results： At the end of 4 weeks of enteral feeding, the augment value of BMI, ALB, PA, Hb and SFT of PEG group were higher than those of NGT group （ all P 〈 0.05 ）. The incidence of acquired pulmonary infections and the positive rate of cultured pathogenic bacterium in sputum and gastric fluid in patients with acquired pulmonary infections were lower in PEG group than those of NGT group. Conclusion： Nutritional therapy with percutaneous endouscopic gastrostomy can achieve nutritional curative effect and can decrease aspiration pneumonia effectively.
出处
《肠外与肠内营养》
CAS
北大核心
2013年第1期19-22,共4页
Parenteral & Enteral Nutrition
关键词
经皮内镜下胃造口术
鼻胃管
肠内营养
肺部感染
颅脑损伤
吞咽障碍
Percutaneous endoscopic gastrostomy
Nasogastric tube
Enteral nutrition
Pulmonary infection
Traumatic brain injury
Dysphagia
