CAJ | 학술논문

目的总结经皮微创胃造瘘术在预防重型颅脑损伤昏迷患者肺部感染及其营养支持治疗中的作用. 方法选择广东省揭阳市人民医院神经外科于2006年1月至2009年12月收治的重型颅脑损伤昏迷患者40例,脑干梗塞后吞咽障碍患者2例共42例作为试验组,应用经皮微创胃造瘘术后营养支持治疗,另外选择经鼻留置胃管鼻饲营养支持治疗的同期42例重型颅脑损伤昏迷患者做为对照组,比较2组患者的肺部感染率并检测患者胃造瘘或鼻饲术前1周、术后1周和2周时血清总蛋白、血清白蛋白、血红蛋白的含量. 结果与对照组比较.试验组患者治疗后2周肺部感染率降低,G+病原菌(肠球菌属)、G-病原菌(大肠埃希菌、阴沟肠杆菌)的感染率降低,差异有统计学意义(P<0.05);实验组与对照组患者胃造瘘或鼻饲术前1周、术后1周和2周时的血清总蛋白、血清白蛋白、血红蛋白的含量差异均无统计学意义(P>0.05). 结论经皮微创胃造瘘术后营养支持能有效消除反复返流所致肺部感染,且不影响营养疗效,是营养支持治疗的理想途径,值得临床推广、应用.
목적 총결경피미창위조루술재예방중형로뇌손상혼미환자폐부감염급기영양지지치료중적작용. 방법 선택광동성게양시인민의원신경외과우2006년1월지2009년12월수치적중형로뇌손상혼미환자40례,뇌간경새후탄인장애환자2례공42례작위시험조,응용경피미창위조루술후영양지지치료,령외선택경비류치위관비사영양지지치료적동기42례중형로뇌손상혼미환자주위대조조,비교2조환자적폐부감염솔병검측환자위조루혹비사술전1주、술후1주화2주시혈청총단백、혈청백단백、혈홍단백적함량. 결과 여대조조비교.시험조환자치료후2주폐부감염솔강저,G+병원균(장구균속)、G-병원균(대장애희균、음구장간균)적감염솔강저,차이유통계학의의(P<0.05);실험조여대조조환자위조루혹비사술전1주、술후1주화2주시적혈청총단백、혈청백단백、혈홍단백적함량차이균무통계학의의(P>0.05). 결론 경피미창위조루술후영양지지능유효소제반복반류소치폐부감염,차불영향영양료효,시영양지지치료적이상도경,치득림상추엄、응용.
Objective To study the effects of percutaneous endoscopic gastrostomy on coma patients with severe brain injury in preventing the pulmonary infection and supporting the nutritional therapy. Methods Forty coma patients with severe brain injury and 2 dysphgia patients with brain stem infarction, admitted to our hospital from January 2006 to December 2009 were chosen as experimental group and given nutritional therapy after percutaneous endoscopic gastrostomy. The other 42 coma patients with severe brain injury admitted to our hospital at the same period were chosen as control group and given nasal-feeding nutrition. The degree of lung infection and the contents of serum total protein, serum albumin and hemoglobin 1 w before, and 1 and 2 w after the surgery in the 2 groups were detected. Results All of the patients (40 in coma and 2 not being able to eat) benefited from percutaneous endoscopic gastrostomy: the pulmonary infection caused by esophageal back flow was prevented; the infection rate of G+ pathogenic bacteria and the G-pathogenic bacteria in the experimental group was 0significantly decreased as compared with that in the control group (P<0.05). No significant differences of the contents of serum total protein, serum albumin and hemoglobin at each time points between the 2 groups were noted (P>0.05). Conclusion Nutritional therapy after adopting the percutaneous endoscopic gastrostomy, preventing pulmonary infection caused by esophageal back flow, is a safe method and worth to be generalized.