Denis R, Lucas C E, Grabow D, Darmody W R, Ledgerwood A M
Am Surg. 1983 Jun;49(6):301-3.
The total care of a patient with severe head injury is challenging and may extend for weeks, months, or even years. A major challenge of this care includes nutritional support: swallowing is impaired, aspiration accompanies gastric tube feeding, parenteral nutrition is limited to short term in hospital care, and needle jejunostomy or transabdominal jejunostomy are prone to inadvertent removal. The role of Roux-en-Y feeding jejunostomy was evaluated in 13 patients with acute head injury. Procedure related complications include prolapse of the ostomy (1 patient) and stoma-ischemia requiring revision (1 patient). The effect of ostomy tube feedings on gastric acid secretions was studied in five patients, and no significant change was noted when saline feeding was compared to blenderized diet feeding. Blenderized diet feedings were advanced gradually, and antidiarrheals were added as needed once gastrointestinal function returned. In conclusion, Roux-en-Y feeding jejunostomy provides an attractive, safe method for long-term enteral nutrition in the head injury patient. Easy replacement of the feeding tube facilitates nursing care, and the threat of acid-induced stress gastric bleeding is not enhanced.
对重症颅脑损伤患者的全面护理具有挑战性，可能会持续数周、数月甚至数年。这种护理的一个主要挑战包括营养支持：吞咽功能受损，鼻饲时会出现误吸，肠外营养在住院护理中仅限于短期使用，而经皮穿刺空肠造口术或经腹空肠造口术容易意外拔除。对13例急性颅脑损伤患者评估了Roux-en-Y空肠造口术的作用。与手术相关的并发症包括造口脱垂（1例患者）和需要修复的造口缺血（1例患者）。对5例患者研究了造口管饲对胃酸分泌的影响，比较生理盐水喂养和搅拌饮食喂养时未发现显著变化。逐渐增加搅拌饮食喂养，一旦胃肠功能恢复，根据需要添加止泻药。总之，Roux-en-Y空肠造口术为颅脑损伤患者的长期肠内营养提供了一种有吸引力、安全的方法。喂养管易于更换便于护理，且不会增加酸诱导应激性胃出血的风险。
