Abstract:

Objective　To investigate the effect of nutritional support through straight nasointestinal tube on nutritional status in critically ill elderly patients. Methods　This was a prospective study. A total of 36 elderly patients in critical conditions hospitalized at Department of Intensive Care Medicine, Nanjing Jiangbei Hospital, Nantong University were selected from March 2021 to July 2022, including 28 males and 8 females. They were (72.28±13.97) years old; their BMI was (23.58±3.36) kg/m²; the score of nutritional risk screening (NRS 2002) was (6.00±0.77); the score of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was (22.33±2.47). The straight nasointestinal tubes were blindly inserted by their bedsides for the patients' nutritional support. The nutritional conditions before and 7, 14, 21, and 28 days after the nutritional support were compared. LSD-t test and χ² test were applied. Results　The success rate of blind insertion of straight nasointestinal tube at one time was 94.44% (34/36). The levels of hemoglobin and albumin were higher after than before the treatment, and the overall differences were statistically significant (F=7.561 and 6.987; both P<0.05). There were statistical differences in the levels of hemoglobin, total protein, albumin, prealbumin, and blood glucose between before and after the treatment (all P<0.05). There were statistical differences in the incidences of gastric retention [26/36 (72.22%) vs. 0/36 (0%)], vomiting aspiration [12/36 (33.33%) vs. 1/36 (2.78%)], diarrhea [8/36 (22.22%) vs. 1/36 (2.78%)] and diarrhea [6/36 (16.67%) vs. 1/36(2.78%)] between before and after the treatment (χ²=11.613, 11.359, 6.222, and 3.956; all P<0.05). The intestinal mucosal barrier function (diamine oxidase, D-lactic acid, and bacterial endotoxin) was improved after the treatment, and the overall differences were statistically significant (F=3.322, 10.957, and 14.016; all P<0.05). There were statistical differences 14, 21, and 28 d after the treatment (all P<0.05). Conclusions　The success rate of blind insertion of straight nasointestinal tube at one time is high; it can improve the nutritional status, reduce the incidence of feeding intolerance, and protect the intestinal mucosal barrier function.

Key words:

Intestinal mucosal barrier, Straight nasointestinal tube, Critically ill elderly patients, Nutritional status, Intolerance of feeding

摘要：

目的　探讨直型鼻肠管营养支持对老年重症患者营养状况的影响。方法　本研究为前瞻性研究，选择2021年3月至2022年7月在南通大学附属南京江北医院重症医学科住院的老年重症患者36例，其中男28例、女8例，年龄（72.28±13.97）岁，体质量指数（23.58±3.36）kg/m²，营养风险筛查2002（NRS 2002）评分为（6.00±0.77）分，急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）评分为（22.33±2.47）分。床旁盲插直型鼻肠管行营养支持治疗，对比营养支持前与营养支持后7 d、14 d、21 d和28 d营养状况改善情况。统计学方法采用LSD-t检验、χ²检验。结果　36例患者盲插直型鼻肠管一次置管成功率为94.44%（34/36）；患者血红蛋白、白蛋白均较治疗前升高，总体比较差异均有统计学意义（F=7.561、6.987，均P<0.05）；经多组间比较血红蛋白、总蛋白、白蛋白、前白蛋白和血糖治疗前后比较差异均有统计学意义（均P<0.05）；治疗前后胃潴留、呕吐误吸、腹泻和腹胀比较［72.22%（26/36）比0%、33.33%（12/36）比2.78%（1/36）、22.22%（8/36）比2.78%（1/36）、16.67%（6/36）比2.78%（1/36）］，差异均有统计学意义（χ²=11.613、11.359、6.222、3.956，均P<0.05）；治疗后肠黏膜屏障功能（二胺氧化酶、D-乳酸、细菌内毒素）好转，总体比较差异均有统计学意义（F=3.322、10.957、14.016，均P<0.05）；经多组间比较治疗14 d、21 d和28 d差异均有统计学意义（均P<0.05）。结论　盲插直型鼻肠管一次置管成功率高，可改善老年重症患者营养状况，降低喂养不耐受发生率，保护肠黏膜屏障功能。

关键词:

肠黏膜屏障, 直型鼻肠管, 老年重症患者, 营养状况, 喂养不耐受