Chen Feixiang, Xu Chao, Zhang Cunhai
Department of Intensive Care Unit, the 117th Hospital of People's Liberation Army, Hangzhou 310013, Zhejiang, China. Corresponding author: Zhang Cunhai, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Jan;30(1):57-60. doi: 10.3760/cma.j.issn.2095-4352.2018.01.011.
To evaluate the effect of indwelling nasointestinal tube for enteral nutrition (EN) support on patients with severe craniocerebral trauma undergoing mechanical ventilation (MV).
A total of 100 severe craniocerebral trauma patients undergoing MV admitted to intensive care unit (ICU) of the 117th Hospital of People's Liberation Army from February 2015 to February 2017 were enrolled, and they were divided into nasogastric tube group in which the EN was fed by nasogastric tube and nasal jejunal feeding tube group (nasointestinal tube group) by random digits table, with 50 patients in each group. Blood urea nitrogen (BUN), hemoglobin (Hb), serum albumin (Alb), acute physiology and chronic health evaluation II (APACHE II) score, Glasgow coma scale (GCS) score before and 10 days after treatment, duration of MV, hospitalization time, and the incidences of ventilator-associated pneumonia (VAP) and reflux wrong aspiration of the two groups were observed and compared.
There was no statistically significant difference in BUN, Hb, Alb, APACHE II score or GCS score before treatment between the two groups. Ten days after treatment, BUN and APACHE II score in the nasointestinal tube group were significantly lower than those in the nasogastric tube group [BUN (mmol/L): 6.3±1.6 vs. 8.0±2.2, APACHE II score: 17.9±3.2 vs. 20.8±6.3, both P < 0.05], Hb, Alb, GCS score were significantly higher than those in nasogastric tube group [Hb (g/L): 125.9±19.7 vs. 113.5±19.6, Alb (g/L): 35.9±6.2 vs. 31.9±6.2, GCS score: 9.7±1.9 vs. 8.2±5.7, all P < 0.05], duration of MV and hospitalization time were significantly less than those in the nasogastric tube group [duration of MV (days): 14.7±3.4 vs. 17.5±2.9, hospitalization time (days): 15.4±5.6 vs. 19.2±7.3, both P < 0.05], and the complication rate in nasointestinal tube group was obviously lower than that in nasogastric tube group [10% (5/50) vs. 36% (18/50), P < 0.05].
For patients with severe craniocerebral trauma treated with MV, the EN treatment by means of indwelling nasointestinal tube is helpful for the recovery of consciousness, improvement of nutritional indexes, reduction of incidences of complications such as reflux aspiration, etc. and shortening the course of disease, thus the method can obviously improve the patients quality of life.
评估留置鼻肠管行肠内营养（EN）支持对重度颅脑外伤机械通气（MV）患者的影响。
选取2015年2月至2017年2月在解放军第117医院重症监护病房（ICU）收治的100例接受MV的重度颅脑外伤患者，采用随机数字表法将其分为经鼻胃管行EN喂养的鼻胃管组和鼻空肠喂养管组（鼻肠管组），每组50例。观察并比较两组治疗前及治疗10 d后的血尿素氮（BUN）、血红蛋白（Hb）、血清白蛋白（Alb）、急性生理与慢性健康状况评分系统II（APACHE II）评分、格拉斯哥昏迷量表（GCS）评分、MV时间、住院时间以及呼吸机相关性肺炎（VAP）和反流误吸的发生率。
两组治疗前BUN、Hb、Alb、APACHE II评分或GCS评分比较，差异均无统计学意义。治疗10 d后，鼻肠管组BUN和APACHE II评分明显低于鼻胃管组[BUN（mmol/L）：6.3±1.6比8.0±2.2，APACHE II评分：17.9±3.2比20.8±6.3，均P<0.05]，Hb、Alb、GCS评分明显高于鼻胃管组[Hb（g/L）：125.9±19.7比113.5±19.6，Alb（g/L）：35.9±6.2比31.9±6.2，GCS评分：9.7±1.9比8.2±5.7，均P<0.05]，MV时间和住院时间明显短于鼻胃管组[MV时间（天）：14.7±3.4比17.5±2.9，住院时间（天）：15.4±5.6比19.2±7.3，均P<0.05]，且鼻肠管组并发症发生率明显低于鼻胃管组[10%（5/50）比36%（18/50），P<0.05]。
对于接受MV治疗的重度颅脑外伤患者，采用留置鼻肠管行EN治疗有助于意识恢复，改善营养指标，降低反流误吸等并发症的发生率，缩短病程，明显提高患者生活质量。
