| 袁淑雅,王留根,赵幸娜,等.间歇性经口至食管管饲对中重型颅脑损伤合并吞咽障碍患者营养状况及吞咽功能的影响[J].中华物理医学与康复杂志,2026,48(9):797-801 |
| 间歇性经口至食管管饲对中重型颅脑损伤合并吞咽障碍患者营养状况及吞咽功能的影响 |
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| DOI：10.3760/cma.j.cn421666-20251009-00900 |
| 中文关键词: 颅脑损伤 间歇性经口至食管管饲法 吞咽障碍 营养不良 |
| 英文关键词: Traumatic brain injury Intermittent oro-esophageal tube feeding Dysphagia Malnutrition |
| 基金项目:河南省科技厅重点研发专项（241111310600） |
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| 中文摘要: |
| 目的 探讨间歇性经口至食管管饲（IOE）对中重型颅脑损伤合并吞咽障碍患者营养状况及吞咽功能的影响。 方法 采用随机数字表法将92例中重型颅脑损伤合并吞咽障碍患者分为观察组及对照组，每组46例。2组患者均接受颅脑损伤常规处理及吞咽功能训练，在此基础上观察组采用IOE方式进行肠内营养支持，对照组则采用鼻胃管管饲法（NGT）进行肠内营养支持。于入组4 h内、干预4周后检测2组患者血清血红蛋白（Hb）、白蛋白（Alb）及前白蛋白（PA）等营养指标含量，采用功能性经口摄食量表（FOIS）评估患者吞咽功能，采用临床肺部感染量表（CPIS）评估患者肺部感染情况，并记录治疗期间2组患者并发症发生情况；于干预结束3个月后随访2组患者的管饲状况及喂饲相关不良事件发生情况。 结果 入组时，2组患者血清Hb、Alb、PA含量、FOIS评分及CPIS评分组间差异均无统计学意义（P>0.05）；干预4周后观察组血清Hb、Alb、PA含量［分别为（121.8±15.5）g/L、（39.8±5.1）g/L和（263.4±41.8）mg/L］、FOIS评分［（3.96±0.41）分］、CPIS评分［（1.72±1.23）分］及胃食管反流发生率均显著优于对照组水平（P<0.05）。干预结束3个月后随访时，发现观察组处于“经口摄食不足予以管饲补充”阶段的患者占比显著高于对照组（P<0.05），而完全依赖管饲的患者占比及喂饲相关不良事件发生率均显著低于对照组（P<0.05）。 结论 IOE能有效改善中重型颅脑损伤合并吞咽障碍患者的营养状况及吞咽功能，抑制相关并发症发生，加速康复进程，更适用于需长期肠内营养支持的患者。 |
| 英文摘要: |
| Objective To investigate the effects of intermittent oro-esophageal tube feeding (IOE) on nutritional status and swallowing function in patients with moderate to severe traumatic brain injury (TBI) complicated by dysphagia. Methods A total of 92 patients with moderate-to-severe TBI and dysphagia were randomly assigned via a random number table to an observation group or a control group, with 46 patients in each group. In addition to routine TBI management and swallowing function training, the observation group received enteral nutrition support via IOE, while the control group underwent enteral nutrition support via nasogastric tube feeding (NGT). Serum nutritional parameters, including hemoglobin (Hb), albumin (Alb), and prealbumin (PA), were measured within 4 hours after enrollment and at 4 weeks post-intervention. Swallowing function was assessed using the Functional Oral Intake Scale (FOIS), and pulmonary infection was evaluated with the Clinical Pulmonary Infection Score (CPIS). Complications during the treatment period were also recorded for both groups. At 3 months post-intervention, follow-up was conducted to record tube-feeding status and feeding-related adverse events. Results At baseline, there were no significant differences between the two groups in serum Hb, Alb, PA levels, FOIS scores, or CPIS scores (all P>0.05). At 4 weeks post-intervention, the observation group demonstrated significantly better outcomes than the control group in terms of serum Hb, Alb, and PA levels ［(121.8±15.5) g/L, (39.8±5.1) g/L, and (263.4±41.8) mg/L, respectively］, FOIS scores (3.96±0.41), CPIS scores (1.72±1.23), and the incidence of gastroesophageal reflux (all P<0.05). At the 3-month follow-up, the proportion of patients in the observation group at the stage of "oral intake with supplemental tube feeding" was significantly higher than that in the control group (P<0.05), whereas the proportions of patients completely dependent on tube feeding and the incidence of feeding-related adverse events were significantly lower than the latter group (P<0.05). Conclusions IOE can effectively improve nutritional status and swallowing function, reduce the occurrence of related complications, and accelerate the recovery process in patients with moderate-to-severe TBI and dysphagia. It is particularly suitable for patients requiring long-term enteral nutrition support. |
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