【作者】 黄从刚； 张严国； 罗明； 何主强； 丁伟； 王兴弯； 罗志华； 张勤； 周洁； 王俊； 段发亮；

【Author】 HUANG Cong-gang;ZHANG Yan-guo;LUO Ming;HE Zhu-qiang;DING Wei;WANG Xing-wan;LUO Zhi-hua;ZHANG Qin;ZHOU Jie;WANG Jun;DUAN Fa-liang;Department of Neurosurgery and Interventional radiology,the First Hospital of Wuhan;

【机构】 武汉市第一医院(华中科技大学附属武汉市中西医结合医院)；

【摘要】 目的探讨重症脑出血患者肠内营养支持治疗中经皮内镜下胃空肠造瘘术的疗效。方法回顾性分析2015年1月至2018年12月武汉市第一医院神经外科收治的86例重症脑出血患者,行肠内营养支持治疗。数字抽签分为鼻胃置管(NG)组44例和经皮内镜下胃空肠造瘘术置管(PEG/PEJ)组42例,比较两组患者肠内营养并发症的发生率、平均住院时间及平均住院费用的差异。结果两组患者的一般资料具有可比性,差异无统计学意义(均P>0.05)。PEG/PEJ组患者的腹泻发生率[14.6%(6/41)]、胃潴留发生率[34.1%(14/41)]、低蛋白血症发生率[26.8%(11/41)]均显著低于NG组患者[分别为38.6%(17/44)、59.1%(26/44)、47.7%(21/44),均P<0.05]。但PEG/PEJ组患者的管道堵塞率[34.1%(14/41)]明显高于NG组患者[11.4%(5/44),P=0.012],差异均有统计学意义。两组患者发生肺部感染的比例均较大[NG组&PEG/PEJ组:97.7%(43/44)&92.79%(38/41),P=0.273],差异无统计学意义。PEG/PEJ组患者的平均住院时间(35.2±4.7,d)低于NG组患者(37.6±5.4,d),P=0.032,差异有统计学意义。两组患者的平均住院费用相比大致相同[NG组&PEG/PEJ组:(21.6±3.9) w&(19.7±6.4)w,P=0.100],差异无统计学意义。结论对重症脑出血患者采用经皮内镜下胃空肠造瘘术置管的肠内营养治疗方式,可降低腹泻、胃潴留、低蛋白血症并发症的发生率,缩短平均住院时间,但应注意降低胃空肠造瘘术置管的堵管率。更多还原

【Abstract】 Objective To investigate the therapeutic effect of enteral nutrition through percutaneous endoscopic gastrostomy/jejunostomy in patients with severe cerebral hemorrhage.Methods A total of 86 patients with severe cerebral hemorrhage admitted to the Neurosurgery Department of Wuhan the first hospital from January 2015 to December 2018 were enrolled into this retrospective study.According to the ways of enteral nutrition,all 86 patients were divided into nasogastric tube nutrition group(n=44) and percutaneous endoscopic gastrostomy/jejunostomy(PEG/PEJ) tube nutrition group(n=42) in order to evaluate their differences in rate of complications related to enteral nutrition(diarrhea,gastric retention,hypoproteinemia,pulmonary infection and obstruction of ducts),mean hospitalization time and mean hospitalization cost were compared between the two groups.Results The 2 groups were comparable in patients’ sex,age,Nutrition risk screening 2002,location and types of cerebral hemorrhage,Glasgow coma score,surgical treatment and starting time of enteral nutrition(all P>0.05).The rates of diarrhea(14.6%,6/41),The rates of gastric retention(34.1%,14/41),and the rates hypoproteinemia(26.8%,11/41) in PEG/PEJ tube group were significantly lower than those in tube NG group [38.6%(17/44),59.1%(26/44),and 47.7%(21/44),respectively,all P <0.05].However,the rates of obstruction ducts(34.1%,14/41) in PEG/PEJ tube group was significantly higher than that in NG tube group(11.4%,5/44).The rates of pulmonary infection was relatively high in both tube groups[NG vs PEG/PEJ:(97.7%,43/44) vs(92.7%,38/41)],there were no significant differences.Compared with the patients in the NG tube group,the average hospitalization time(35.2±4.7 d vs 37.6±5.4 d) was shorter in PEG/PEJ tube group.But,there was no significant differences in the mean hospitalization cost between 2 group,as they cost so much.Conclusions The enteral nutrition treatment with percutaneous endoscopic gastrostomy/jejunostomy tube for severe cerebral hemorrhage could significantly reduce the rates of diarrhea,gastric retention and hypoproteinemia and shorten the time average hospitalized patients.We should pay attention to reduce the rate of obstruction of percutaneous endoscopic jejunostomy ducts.更多还原