卒中患者肠内营养的实施-华瑞北京.ppt

克服胃排空延迟

监测胃内容物残留量胃排空延迟Page*3合理的胃内容物监测21选择经空肠喂养使用胃肠动力药物肠内营养途径的选择管饲肠内营养管饲的途径Page*01040203鼻胃管鼻空肠管PEGPEJ鼻胃管Page*PEGPage*2005ESPENguidelinesforPEG非急性老年病房:NGTvsPEG-生存率PEG减少老年非急性患者的死亡率(hazardratio(HR)=0.41;95%confidenceinterval(CI)0.22-0.76;P=0.01).01PEG减少误吸的风险(HR=0.48;95%CI0.26-0.89)02PEG减少自拔管率(HR=0.17;95%CI0.05-0.58)03CONCLUSIONPage*ClinicalNutrition(2001)20(6):535±540PEG具有更好的耐受性降低误吸的风险非急性期，长期肠内营养的患者使用PEG可以提高存活率Food3-早期PEGvsNGT对mRS的影响321patientswereenrolledby47hospitalsin11countries01早期PEG绝对增加1%(-10.0to11.9,p=0.9)的死亡风险02早期PEG增加死亡或者不良预后，7.8%(0.0to15.5,p=0.05)03FOODtrial3:EffectoffeedingviaPEGversusnasogastrictube功能独立性评定（functionalindependencemeasure,FIM）Intensivenutritionalsupplementscanimproveoutcomesinstrokerehabilitation.RabadiMH,CoarPL,LukinM,LesserM,BlassJP.VAMedicalCenter,921NE13thStreet,OklahomaCity,OK73104,USA.mhrabadi@OBJECTIVE:Poornutritionisacommoncomplicationofstrokessevereenoughtorequireinpatientrehabilitation.Wethereforetestedwhetherintensivenutritionalsupplementsgiventoundernourishedpatientsfromthetimeoftheiradmissiontoaspecializedstrokerehabilitationservicewouldimprovepatientoutcomes.METHODS:Randomized,prospective,double-blind,singlecenterstudycomparingintensivenutritionalsupplementationtoroutinenutritionalsupplementationin116undernourishedpatientsadmittedtoastrokeservice.Theanalysisincludedthe90%ofpatientswhowerenotlosttofollow-upduetoacuteorsubacutehospitalization(n=102;51ineachgroup).ThenutritionalsupplementsarecommerciallyavailableandFoodandDrugAdministrationapproved.TheprimaryoutcomevariablewaschangeintotalscoreontheFunctionalIndependenceMeasure(FIM).ThesecondaryoutcomemeasurementsincludedtheFIMmotorandcognitivesubscores,lengthofstay(takenfromdayofadmission),2-minuteand6