CAJ | 학술논문

目的：探讨亚甲蓝排泄试验在重症高血压脑出血患者早期实施合理营养支持中的应用价值。方法将2010年1月至2013年3月入院的重症高血压脑出血患者83例作为研究组，将2006年1月至2009年12月入院的同类患者78例作为对照组。研究组患者于入院第3、8、15天进行亚甲蓝排泄试验，根据患者尿液变蓝色的时间确定实施肠内营养、肠内＋肠外营养或肠外营养三种方式；对照组常规先采用肠内营养支持治疗，15 d后仍不能耐受肠内营养者改为肠外营养治疗。观察两组患者体重、血清白蛋白、前白蛋白及血红蛋白等营养情况以及并发症的发生情况。3个月时按日常生活能力（ADL）分级法评定预后，将Ⅰ～Ⅲ级归为预后良好，Ⅳ～Ⅴ级及死亡归为预后不良。结果研究组治疗3周后体重明显重于对照组，治疗14 d、21 d后的血清白蛋白、前白蛋白及血红蛋白明显高于对照组，营养状态明显优于对照组，而并发症明显少于对照组，3个月后研究组预后良好率（72.29%）明显高于对照组（55.13%），差异有统计学意义（χ2＝5.14，P＜0.05）。结论根据亚甲蓝排泄试验来确定重症高血压脑出血患者早期合理营养支持方式，可为患者合理提供全面营养，增强机体抵抗力，降低并发症发生率，对改善预后有重要的临床价值。
목적：탐토아갑람배설시험재중증고혈압뇌출혈환자조기실시합리영양지지중적응용개치。방법장2010년1월지2013년3월입원적중증고혈압뇌출혈환자83례작위연구조，장2006년1월지2009년12월입원적동류환자78례작위대조조。연구조환자우입원제3、8、15천진행아갑람배설시험，근거환자뇨액변람색적시간학정실시장내영양、장내＋장외영양혹장외영양삼충방식；대조조상규선채용장내영양지지치료，15 d후잉불능내수장내영양자개위장외영양치료。관찰량조환자체중、혈청백단백、전백단백급혈홍단백등영양정황이급병발증적발생정황。3개월시안일상생활능력（ADL）분급법평정예후，장Ⅰ～Ⅲ급귀위예후량호，Ⅳ～Ⅴ급급사망귀위예후불량。결과연구조치료3주후체중명현중우대조조，치료14 d、21 d후적혈청백단백、전백단백급혈홍단백명현고우대조조，영양상태명현우우대조조，이병발증명현소우대조조，3개월후연구조예후량호솔（72.29%）명현고우대조조（55.13%），차이유통계학의의（χ2＝5.14，P＜0.05）。결론근거아갑람배설시험래학정중증고혈압뇌출혈환자조기합리영양지지방식，가위환자합리제공전면영양，증강궤체저항력，강저병발증발생솔，대개선예후유중요적림상개치。
ObjectiveTo investigate the application value of methylene blue excretive test in the early stage of comprehensive nutrition support for severe hypertensive intracerebral hemorrhage.MethodsThe 83 cases of severe hypertensive intracerebral hemorrhage admitted to hospital from Jan. 2010 to Mar. 2013 were chosen as study group, while the 78 cases of similar patients admitted to hospital from Jan. 2006 to Dec. 2009 were chosen as control group. Nasal feeding were given to the study group in 3rd,8th and 15th day after admission to determine the support ways of implementation of enteral nutrition, enteral+parenteral nutrition or total parenteral nutrition according to the elimination time of methylene blue in patients' urine. The control group conventionally receive enteral nutrition support therapy firstly, after 15 days if they still cannot keep the enteral nutrition, then change to give them parenteral nutrition therapy. To observe the weight, serum albumin, prealbumin and hemoglobin circumstances of the two groups patients. Recorded the complications of patients. The patients were followed up according to activity of daily living(ADL) after 3 months.ResultsThe average body weight of the study group was significantly higher than that of control group after 3 weeks. The serum albumin, prealbumin and hemoglobin of the study group were significantly higher than that of the control group after 14 d and 21 d. Nutritional status was significantly better than that of the control group, and complications was significantly less than that of the control group. After 3 months, the good prognosis rate of study group (72.29%) was significantly higher than that of the control group (55.13%), the difference was statistically significant (χ2=5.14,P<0.05). ConclusionBy confirming comprehensive nutrition support way for patients with severe hypertensive intracerebral hemorrhage in the early stage according to the elimination time of methylene blue in the urine, it can provide comprehensive nutrition to patients, enhance their body resistance, reduce the incidence of complications, andcreate an important clinical value for improving prognosis.