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目的观察含中链甘油三酯(MCT)的肠内营养制剂对脑卒中患者营养状况及肠内营养并发症的影响。方法将2014年7月至12月收治的58例脑卒中患者随机分为含MCT肠内营养制剂组(MCT组)和自制匀浆膳组(对照组),每组各29例。置鼻胃管24 h内给予肠内营养支持且时间大于1个月,分别测定患者肠内营养支持前、第2周和第4周人体成分、血生化相关指标并监测肠内营养并发症发生情况。结果营养支持第2周时两组血清总蛋白(TP)、白蛋白(ALB)、血红蛋白(Hb)及高密度脂蛋白胆固醇(HDL-C)较鼻饲前均下降(P<0.05或P<0.01),而对照组血糖升高(P<0.05);第4周时MCT组与对照组相比血清ALB、Hb及HDL-C显著增高,而LDL-C显著降低(P均<0.05)。体成分方面:第2周时对照组患者肌肉重和第4周时肌肉重、去脂体重及蛋白质重较鼻饲前均降低(P<0.05或P<0.01),而脂肪率增高(P<0.05),第4周时MCT组与对照组相比肌肉重、去脂体重及蛋白质均增加(P均<0.05)。MCT组较对照组肠内营养并发症发生率偏低,其中便秘和高血糖的发生率有明显差异(P均<0.05)。胃肠耐受及并发症情况:对照组便秘及高血糖多于MCT组(P均<0.05)。结论含MCT的肠内营养制剂较传统自制匀浆膳能够改善脑卒中患者营养状况,改善蛋白及血脂水平,降低肠内营养并发症的发生。
Objective To investigate the effects of enteral nutrition with medium chain triglyceride (MCT) on nutritional status and enteral nutrition complications in patients with stroke. Methods Fifty-eight stroke patients admitted from July 2014 to December 2014 were randomly divided into MCT enteral nutrition group (MCT group) and self-made homogenate diet group (control group), with 29 patients in each group. Nasogastric tube was given enteral nutrition for 24 hours and the time was longer than one month. The indexes of human body composition and blood biochemistry before, during the second week and the fourth week of enteral nutrition support were determined, and the complication of enteral nutrition was monitored Happening. Results At the second week of nutritional support, serum TP, ALB, Hb and HDL-C in the two groups were significantly lower than those before nasal feeding (P <0.05 or P <0.01) (P <0.05). Compared with the control group, the serum ALB, Hb and HDL-C in the MCT group were significantly increased and the LDL-C levels were significantly decreased in the fourth week (all P <0.05). Body composition: The muscle mass of the control group and the weight of muscle, weight of lean body and protein in the control group decreased significantly (P <0.05 or P <0.01) and increased in the 4th week (P <0.05) ). At 4 weeks, muscle weight, lean body mass and protein increased in MCT group compared with control group (all P <0.05). The incidence of enteral nutrition complication in MCT group was lower than that in control group, and the incidence of constipation and hyperglycemia were significantly different (all P <0.05). Gastrointestinal tolerance and complications: The constipation and hyperglycemia in the control group were more than those in the MCT group (all P <0.05). Conclusion Enteral nutrition preparations containing MCT can improve the nutritional status of stroke patients, improve the level of protein and blood lipid and reduce the occurrence of complications of enteral nutrition compared with the traditional self-made homogenate.