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目的 探讨鼻十二指肠管联合大黄对ICU昏迷患者肠内营养支持的效果.方法 选取2016年4月至2017年4月南宁市第九人民医院ICU收治的120例昏迷患者,采用随机数表法随机分为联合干预组与胃管干预组,每组60例.联合干预组给予鼻十二指肠管联合大黄干预,胃管干预组采用普通胃管模式.两组患者的观察时间均为1周,比较停止肠内营养支持时间、胃动力药物使用量、胃残留量.比较两组患者干预前后的体质量、三头肌皮肤折褶厚度( TSF)、臀肌围、白蛋白,并测定 CD4 +、 CD8 +、 CD4 +/CD8 +、 CD3 +水平.结果 干预后联合干预组患者的胃残留量[(18.01 ±4.35)ml]、平均胃动力药物使用量[(4.22 ± 0.75)ml]明显少于胃管干预组[(29.78 ± 8.28)ml、(6.38 ±0.48)ml],停止肠内营养支持平均时间[(49.65 ±15.96)h]明显短于胃管干预组[(62.36 ±29.94)h],差异有统计学意义(P<0.05).联合干预组患者的体质量、白蛋白等明显增加,精神和体力均有明显好转,皮下脂肪层明显增厚,与胃管干预组比较,差异有统计学意义(P<0.05);联合干预组患者的CD3 +、CD4 +、CD8 +、CD4 +/CD8 +异常例数均少于胃管干预组,差异有统计学意义(P<0.05);联合干预组患者的CD3 +、CD4 +及CD4 +/CD8 +水平高于胃管干预组,CD8 +低于胃管干预组,差异有统计学意义(P<0.05).结论 鼻十二指肠管联合大黄在ICU昏迷患者肠内营养支持中,可有效促进患者机体恢复,明显减少患者的胃残留量与平均胃动力药物使用量,帮助并改善患者的营养状态,缩短停止肠内营养支持平均时间,促进机体的免疫功能恢复.

Objective To investigate the effect of nasal duodenal canal combined with rhubarb on enteral nutrition support in patients with ICU coma. Methods A retrospective study was performed on 120 cases of patient with ICU coma who were admitted from April 2016 to April 2017.Patients were randomly divided into the combined intervention group and gastric tube intervention group, with 60 cases in each group.The nasal duodenal tube combined with rhubarb was given in the combined intervention group,while the gastric tube was used in the general gastric tube model.The observation time of patients in both groups was 1 week,and the time to stop enteral nutrition support,the use of gastric dynamic drugs,and the gastric residue were compared.Body mass,triceps cutaneous fold thickness(TSF),gluteal muscle circumference, albumin of the two groups before and after intervention were compared,and CD4 +,CD8 +,CD4 +/CD8 +and CD3 +levels were measured. Results Combined intervention group after the intervention,the patient's stomach residues was [(18.01 ± 4.35)ml],the average gastric dynamic drug usage was [(4.22 ± 0.75) ml],significantly less than the tube intervention group [(29.78 ± 8.28)ml,(6.38 ± 0.48)ml],stop en-teral nutrition support [(49.65 ± 15.96)hours] average time was significantly shorter than the tube inter-vention group [(62.36 ±29.94)hours],(P<0.05). The body mass and albumin of the patients in the combined intervention group were significantly increased,the mental and physical strength were significantly improved,and the subcutaneous fat layer was significantly thickened.Compared with the gastric tube inter-vention group,the difference was statistically significant(P <0.05).The number of abnormal cases of CD3 +,CD4 +,CD8 +and CD4 +/CD8 +in the combined intervention group was lower than that in the gas-tric tube intervention group,and the difference was statistically significant(P<0.05).The levels of CD3 +, CD4 +and CD4 +/CD8 +in the combined intervention group were higher than those in the gastric tube inter-vention group and lower than those in the gastric tube intervention group( P<0.05). Conclusion Nasal duodenal tube combined with rhubarb can effectively promote the recovery of patients with ICU coma in en-teral nutrition support,significantly reduce the amount of gastric residual and the average amount of gastric dynamic drug use,help and improve the nutritional status of patients,shorten the average time to stop enter-al nutrition support,and promote the recovery of immune function of the body.