Yuan Tianwen, Zeng Guoqing, Yang Qi, He Yang, Kong Peng, Wang Saibo, Zhou Xing, Cao Jun
Department of Interventional Oncology, Dahua Hospital Xuhui District, Shanghai 200237, China.
Department of Internal Medicine Community Health Service Center of Huajing Street Xuhui District, Shanghai 200237, China.
Am J Transl Res. 2021 Jun 15;13(6):6352-6361. eCollection 2021.
To explore the effects of total enteral nutrition (TEN) via nasal feeding and percutaneous radiologic gastrostomy (PRG) on the nutritional status, quality of life, and prognosis in long-term bedridden patients with dysphagia after cerebral infarction.
One hundred and sixty long-term bedridden patients with dysphagia after cerebral infarction were randomly divided into a control group (CG, n=80) and an observation group (OG, n=80). The CG was administered TEN via nasal feeding, and the OG was administered TEN via PRG. The two groups' results were compared.
The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores in the OG were lower than the corresponding scores in the CG at 3 and 6 months after the TEN ( < 0.05). The OG had a higher proportion of high compliance, but a lower proportion of both moderate and low compliance than the CG ( < 0.05). The total incidence of TEN intolerance was 8.75% in the OG, lower than the 20.00% in the CG ( < 0.05). The AST, ALB, ALT, TBIL, Scr, and BUN levels showed no significant differences between the OG and the CG at 3 and 6 months after the TEN ( > 0.05). The IgM, IgG, IgA, hemoglobin, total protein, albumin, and transferrin levels showed no significant differences between the OG and the CG at 3 and 6 months after the TEN ( > 0.05). The incidence of catheterization complications was 20.00% in the OG, higher than the 8.75% in the CG ( < 0.05). The OG had higher SF-36 scores than the CG at 6 months after the TEN ( < 0.05).
Both nasal feeding and TEN via PRG can effectively improve patients' nutritional status, enhance their immune function, and improve their liver and renal function, but TEN after PRG is more effective at reducing intolerance and promoting quality of life in long-term bedridden patients with dysphagia after cerebral infarction. However, TEN after PRG will also increase the occurrence of recent complications, complications that should get additional clinical attention.
探讨经鼻饲管全肠内营养（TEN）和经皮放射学胃造瘘术（PRG）对脑梗死吞咽困难长期卧床患者营养状况、生活质量及预后的影响。
将160例脑梗死吞咽困难长期卧床患者随机分为对照组（CG，n = 80）和观察组（OG，n = 80）。对照组经鼻饲管给予TEN，观察组经PRG给予TEN。比较两组结果。
TEN治疗3个月和6个月时，观察组汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）评分低于对照组相应评分（P < 0.05）。观察组高依从性比例高于对照组，中、低依从性比例低于对照组（P < 0.05）。观察组TEN不耐受总发生率为8.75%，低于对照组的20.00%（P < 0.05）。TEN治疗3个月和6个月时，观察组与对照组的谷草转氨酶（AST）、白蛋白（ALB）、谷丙转氨酶（ALT）、总胆红素（TBIL）、肌酐（Scr）和尿素氮（BUN）水平比较，差异无统计学意义（P > 0.05）。TEN治疗3个月和6个月时，观察组与对照组的免疫球蛋白M（IgM）、免疫球蛋白G（IgG）、免疫球蛋白A（IgA）、血红蛋白、总蛋白、白蛋白和转铁蛋白水平比较，差异无统计学意义（P > 0.05）。观察组置管并发症发生率为20.00%，高于对照组的8.75%（P < 0.05）。TEN治疗6个月时，观察组健康调查简表（SF - 36）评分高于对照组（P < 0.05）。
经鼻饲管和经PRG的TEN均可有效改善患者营养状况，增强免疫功能，改善肝肾功能，但PRG后TEN在降低脑梗死吞咽困难长期卧床患者不耐受情况及提高生活质量方面更有效。然而，PRG后TEN也会增加近期并发症的发生，这些并发症应引起临床更多关注。
