经皮微创胃造瘘后营养支持治疗重型颅脑损伤昏迷患者疗效观察

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.

Percutaneous endoscopic gastrostomy in nutritional supporting and pulmonary infection preventing of coma patients with severe brain injury

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.