【作者】 张莹；

【导师】 韩杰；

【作者基本信息】 大连医科大学 ， 神经病学， 2012， 硕士

【摘要】 目的：探讨急性重症脑血管病患者入院后72小时内胃动力功能状况的变化，以期为急性重症脑血管病患者及时进行肠内营养支持治疗提供参考。方法：采用方便抽样法，选取大连医科大学附属一院神经内科重症监护病房2011年1月至2012年2月急性重症脑血管病患者80例。通过对急性重症脑血管病患者进行鼻胃管注水试验，记录每次注水量与抽吸残液量。对注水后抽吸残液量小于注入量1/2者起始肠内营养，以后每6小时抽吸胃内残留液，连续观察72h，其间死亡者终止观察。统计方法采用SPSS17．0统计软件包进行数据分析。对所有计量资料进行正态性检验，正态分布用t检验，非正态数据采用秩和检验，相关性分析用Spearman检验，以P<0.05为差异有统计学意义。结果：1．本组80例患者的胃动力功能恢复时间（31.94±21.626h）呈偏态分布，于观察期的前24小时，累计有55%胃肠动力功能有所恢复；前48小时，累计有82.5%胃肠动力功能有所恢复。72小时内未恢复者为9人，其中8人死亡。2．本组80例患者，当性别不同、疾病类型不同时，胃动力功能恢复时间呈非正态分布，使用秩和检验进行发现：男性与女性相比，男性比女性恢复更快，差异有统计学意义（p=0.014）；脑梗死与脑出血这两种疾病类型相比，胃动力功能恢复时间的差异无统计学意义（p=0.481）。3．本组80例患者入院后进行GCS评分，均存在不同程度的意识不清，鼻饲后监测胃动力功能恢复时间，通过Spearman相关分析，双侧检验，发现胃动力功能恢复时间与昏迷程度之间存在显著负相关（R=-0.705，P=0.00）。4．本组80例患者中，于观察期内注水试验阴性后给予肠内营养者70例。其中1例在进行抽液法观察时，已超过72小时。69例进行抽液法观察时，有3例患者在进行EN时出现胃内容物潴留（占4.35%），其中2例于短期内死亡，1例调整EN速度后监测未出现胃潴留。结论：1.急性重症脑血管病患者入院后24～48小时内可逐渐给予肠内营养。2.急性重症脑血管病患者患男性与女性相比，男性胃动力功能恢复更快。3.急性重症脑血管病患者昏迷程度越重，胃动力功能恢复越慢。4．鼻胃管注水试验与肠内营养衔接良好，具有一定的可操作性，可用于急性重症脑血管病患者的胃动力功能监测。更多还原

【Abstract】 Objective: Investigate the changes in gastric motility in functional status within72hours after admission of patients with severe acute cerebrovascular disease, in orderto timely enteral nutrition to provide a reference for patients with severe acutecerebrovascular disease.Methods:Using convenience sampling technique was used in patients with acute severecerebrovascular disease80cases, the First Affiliated Hospital of Dalian MedicalUniversity, Department of Neurology, intensive care unit from January2011toFebruary2012. Record each time the water injection and aspiration residual volumesvia nasogastric tube injection test, acute severe in patients with cerebrovascular disease.Suction on the water after the residue amount is less than the injection rate1/2by thestart of enteral nutrition, every six hours after pumping the stomach of fluid remaining,continuous observation of72h, during which those who died in termination ofobservation.Statistical Methods SPSS17.0statistical package for data analysis. Allmeasurement data normality test, Wilcoxon test was used, normal t-test, non-normaldata, correlation analysis with Spearman test, the difference was statistically significant(P <0.05).Results:1. This group80cases of gastric motility in patients with functional recovery(31.94±21.626h) showed a skewed distribution, the first24hours of the observation period, a total of55%of gastrointestinal motility function has been restored; the first48hours, a total of82.5%gastrointestinal motility function was restored. Not restoredwithin72hours for nine people, eight of whom died.2.80patients in this group, different gender, type of disease, gastric motilityfunction recovery time was non-normal distribution, using the Wilcoxon rank sum testfound: men and women, more men than women recover faster, the difference wasstatistically significance (p=0.014); compared to these two types of disease cerebralinfarction and cerebral hemorrhage, gastric motility function recovery time was nosignificant difference (p=0.481).3. The group of80patients after admission GCS score, there are different levels ofconsciousness, monitoring gastric motility function after the recovery time in the nasalfeeding through the Spearman correlation analysis, two-sided test and found that gastricmotility in functional recovery between time and coma exist a significant negativecorrelation (R=-0.705, P=0.00).4. The group of80patients,70cases of enteral nutrition after the observationperiod injection test negative.1cases during the pumping fluid was observed, more than72hours. Aspiration was observed in69cases, three patients during EN retention ofstomach contents (4.35%), two cases of death within a short period, and one cases ofadjustment EN speed monitoring does not appear to gastric retention.Conclusion:1. Severe acute cerebrovascular disease in patients admitted to hospital within24to48hours after gradually enteral nutrition.2. With acute severe cerebrovascular disease patients suffering from the men andwomen, male of gastric motility functional recovery faster.3. Acute severe cerebral vascular disease in patients with coma extent the moresevere gastric motility in functional recovery slower.4. Nasogastric tube injection test and enteral nutrition, good convergence, theoperability can be used in patients with severe acute cerebrovascular disease in patientswith gastric motility function monitoring.更多还原