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目的:探讨序贯肠内营养(EN)支持治疗在脑卒中合并吞咽功能障碍老年病人治疗中的应用和临床效果。方法:将62例急性缺血性脑卒中合并吞咽功能障碍的老年病人随机分为研究组和对照组。研究组(n=32)病人给予短肽型EN制剂,逐步过渡至整蛋白型EN制剂的序贯EN治疗方案。对照组(n=30)病人直接给予整蛋白型EN制剂。观察两组病人入组第1和第14天的营养指标、免疫功能指标和神经功能缺损评分(NIHSS)的变化以及并发症的发生情况。结果:入组第14天,两组病人的营养指标、免疫功能指标和NIHSS评分均较第1天明显下降(P<0.05)。研究组与对照组比,营养指标和免疫功能指标下降的程度均较轻(P<0.05),NIHSS评分下降程度无显著性差异(P>0.05)。研究组病人总并发症的发生率少于对照组(P<0.05)。结论:序贯EN支持治疗能减轻脑卒中合并吞咽功能障碍的老年病人营养不良发展程度和免疫功能下降程度,促进神经功能恢复,降低并发症发生的风险。
Objective: To investigate the application and clinical effect of sequential enteral nutrition (EN) supportive therapy in elderly patients with stroke and swallowing dysfunction. Methods: A total of 62 elderly patients with acute ischemic stroke and swallowing dysfunction were randomly divided into study group and control group. Patients in the study group (n = 32) received a sequential EN regimen of short peptide EN preparation and gradual transition to the whole protein EN preparation. Patients in the control group (n = 30) were given the whole protein EN preparation. The nutritional indexes, the changes of immune function index and neurological deficit score (NIHSS) and the incidence of complications on the first and the fourteenth days of the two groups were observed. Results: On the 14th day after admission, the nutritional indexes, immune function indexes and NIHSS scores of both groups were significantly lower than those on the first day (P <0.05). Compared with the control group, the indexes of nutrition and immunity decreased less in the study group and the control group (P <0.05), but there was no significant difference in the NIHSS scores (P> 0.05). The incidence of total complication in study group was less than that in control group (P <0.05). Conclusion: Sequential EN supportive therapy can reduce the degree of malnutrition and the decline of immune function in elderly patients with stroke complicated with swallowing dysfunction, promote neurological function recovery and reduce the risk of complications.