Abstract:

Objective　To explore the nursing based on the enteral nutrition support strategy for neurosurgical critically ill patients with dysphagia. Methods　One hundred and eighty neurosurgical critically ill patients with dysphagia admitted to Wuxi Second People's Hospital from January 2021 to January 2023 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 90 cases in each group. There were 50 males and 40 females in the control group; they were (56.11±3.58) years old. There were 48 males and 42 females in the observation group; they were (56.26±3.85) years old. The control group took traditional nursing intervention, and the observation group took the enteral nutrition support strategy on the basis of control group. The clinical indicators, incidences of complications, and nutritional indicators, scores of Glasgow Coma Scale (GCS) and Dysphagia Severity Rating Scale (VGF), and immune indicators before and 2 weeks after the intervention and were compared between the two groups. t and χ² tests were applied. Results　The NSICU stay and ventilator support time in the observation group were shorter than those in the control group [(12.01±2.68) d vs. (13.59±3.02) d and (5.03±1.02) d vs. (6.68±1.30) d], with statistical differences (t=3.712 and 9.473; both P<0.001). Two weeks after the intervention, there were statistical differences in the levels of albumin (ALB), prealbumin (PAB), and total protein (TP) and the scores of GCS and VGF between the observation group and the control group [(40.54±2.12) g/L vs. (33.57±2.03) g/L, (39.25±3.41) g/L vs. (30.26±2.68) g/L, (70.64±5.74) g/L vs. (62.31±5.11)g/L, (13.54±1.67) vs. (9.11±1.05), and (8.56±1.21) vs. (7.21±1.03); t=22.528, 19.664, 10.283, 21.304, and 8.060; all P<0.001]. There were statistical differences in the levels of immunoglobulin (IgA), IgG, and IgM between the observation group and the control group [(2.45±0.65) g/L vs. (2.12±0.49) g/L, (13.89±2.14) g/L vs. (12.44±2.02) g/L, and (1.92±0.63) g/L vs. (1.57±0.52) g/L; t=3.846, 4.674, and 4.065; all P<0.001]. The incidence of complications in the observation group was lower than that in the control group [5.56% (5/90) vs. 14.44% (13/90)], with a statistical difference (χ²=3.951; P=0.047). Conclusion　Nursing based on the enteral nutrition support strategy for neurosurgical critically ill patients with dysphagia can effectively shorten their NSICU stay and ventilator support time, improve their nutritional indicators, swallowing function, and immune function, and reduce the incidence of complications.

Key words:

Enteral nutrition support, Neurosurgical critical illness, Dysphagia, Nutritional indicators

摘要：

目的　探讨基于肠内营养支持策略对神经外科重症合并吞咽功能障碍患者的护理研究。方法　选取2021年1月至2023年1月无锡市第二人民医院收治的180例神经外科重症合并吞咽功能障碍患者进行随机对照试验，按照随机数字表法将患者分为对照组与观察组，各90例。对照组采用传统护理干预，其中男50例，女40例，年龄（56.11±3.58）岁；观察组在对照组基础上加用肠内营养支持策略，其中男48例，女42例，年龄（56.26±3.85）岁；比较两组患者的临床指标、并发症发生率，干预前与干预2周后的营养指标、格拉斯哥昏迷指数（GCS）评分、吞咽障碍程度（VGF）评分、免疫指标水平。统计学方法采用t检验、χ²检验。结果　观察组患者的神经外科重症监护病房（NSICU）住院天数为（12.01±2.68）d、呼吸机支持时间为（5.03±1.02）d，对照组分别为（13.59±3.02）d、（6.68±1.30）d，两组比较差异均有统计学意义（t=3.712、9.473，均P<0.001）。干预2周后，观察组患者白蛋白（ALB）水平为（40.54±2.12）g/L、前白蛋白（PAB）为（39.25±3.41）g/L、总蛋白（TP）为（70.64±5.74）g/L、GCS评分为（13.54±1.67）分、VGF评分（8.56±1.21）分，对照组分别为（33.57±2.03）g/L、（30.26±2.68）g/L、（62.31±5.11）g/L、（9.11±1.05）分、（7.21±1.03）分，两组比较差异均有统计学意义（t=22.528、19.664、10.283、21.304、8.060，均P<0.001）；观察组免疫球蛋白（Ig）A为（2.45±0.65）g/L、IgG为（13.89±2.14）g/L、IgM为（1.92±0.63）g/L，对照组分别为（2.12±0.49）g/L、（12.44±2.02）g/L、（1.57±0.52）g/L，两组比较差异均有统计学意义（t=3.846、4.674、4.065，均P<0.001）。观察组患者并发症发生率（5.56%，5/90）低于对照组（14.44%，13/90），差异有统计学意义（χ²=3.951，P=0.047）。结论　基于肠内营养支持策略的护理能够有效缩短神经外科重症合并吞咽功能障碍患者的NSICU住院天数和呼吸机支持时间，提高患者的营养水平，改善吞咽功能及免疫功能，降低并发症发生率。

关键词:

肠内营养支持, 神经外科重症, 吞咽功能障碍, 营养指标