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Objective:To investigate the effects of intravascular hypothermia combined with early post-pyloric feeding on the neurological function and prognosis in patients with severe ischemic stroke, and to provide a theoretical basis for clinical decision-making on the optimal nutritional support strategy for patients with severe ischemic stroke during intravascular hypothermia treatment.Methods:This was a retrospective, non-randomized, controlled study. A total of 78 patients with first severe ischemic stroke who were admitted to the ICU of Neurology Department, Xuanwu Hospital, Capital Medical University from January 2018 to December 2021 were selected. General information and clinical data of the patients were collected and grouped according to intrvascular hypothermia combined with nutritional support. Patients were divided into early post-pyloric feeding group of 52 cases and early parenteral nutrition group of 26 cases. The neurological prognosis, disease prognosis, nutritional status and complications related to nutritional support of the two groups were retrospectively analyzed.Results:The Glasgow score at 30th day after intravascular hypothermia in the early postpyloric feeding group was (11.25 ± 4.92) points, which was higher than that in the early parenteral nutrition group (8.40 ± 5.53), and the difference was statistically significant ( t=-2.45, P<0.05). After treatment, the serum total protein and hemoglobin of early postpyloric feeding group were (59.56 ± 5.09) g/L and (131.06 ± 19.58) g/L, respectively, which were higher than those of early parenteral nutrition group (56.52 ± 7.94) g/L and (122.07 ± 17.72) g/L. The difference was statistically significant ( t=-2.03, -1.91, P<0.05). The clinical pulmonary infection score of the early postpyloric feeding group was (7.33 ± 0.96) points, which was lower than that of the early parenteral nutrition group (9.42 ± 2.11). The mechanical ventilation time and ICU stay time were (17.46 ± 10.47) days and (28.89 ± 12.59) days, respectively. Compared with the early parenteral nutrition group (25.77 ± 15.20) days and (37.07 ± 17.15) days, the differences were statistically significant ( t=3.28, 2.83, 2.52, all P<0.05). There were no significant differences in catheter-associated bloodstream infection and ICU hospitalization mortality between the two groups (both P>0.05). Conclusions:Intravascular hypothermia combined with early post-pyloric feeding can improve the nutritional status of patients with severe ischemic stroke, effectively control pulmonary infection, shorten mechanical ventilation and hospital stay, and promote neurological repair.
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Objective To compare the effects of two different types of enteral nutrition on postpyloric feeding critical ill patients.Methods A prospective study was conducted to continuously collect 60 critical ill patients with indications ofpost-pyloric feeding in ICU and NICU wards of our hospital from January 2016 to December 2018.They were randomly (random number) divided into the peptide-based enteral nutrition (PBEN) group and intact protein enteral nutrition (IPEN) group with 30 patients in each group.Enteral nutrition was started immediately within 24 h after the nasointestinal tube was placed,and the PBEN group was treated with peptide-based enteral nutrition,while the IPEN group was treated with intact protein enteral nutrition.The nutritional metabolism index,intestinal barrier index on the 7th and 14th days after enteral nutrition treatment were observed and compared.The enteral feeding complications,incidence of feeding intolerance,gastrointestinal adaptability and 7-day enteral nutrition compliance rate of the two groups during the enteral nutrition were also observed and compared.Chi-square test was used for counting data and t test was used for measuring data.Results On the 7th and 14th days after enteral nutrition therapy,there was no statistical difference in nutritional metabolism indexes between the two groups (P＞0.05).In comparison of intestinal barrier indexes,diamine oxidase (DAO) level in the PBEN group was lower than that in the IPEN group at the same time,and the difference was statistically significant [7th day:(6.1±2.9) U/mL vs (7.8±2.7) U/mL,t=-2.354,P=0.019;14th day:(4.7±1.6) U/mL vs (6.9±2.0) U/mL,t=-3.285,P=0.004].During enteral nutrition,the diarrhea rate of patients in the PBEN group was slightly higher than that in the IPEN group (6.6％ vs 3.3％),while the abdominal distension rate in the IPEN group was slightly higher (3.3％ vs 10.0％),but there was no statistical difference between the two groups (P＞0.05).The gastrointestinal adaptation time of patients in the PBEN group was significantly shorter than that in the IPEN group [(7.8±1.3) h vs (9.1±2.0) h,t=-2.334,P=0.027].The 7-day enteral nutrition compliance rate showed no significant difference between the two groups(P＞0.05).Conclusions Diarrhea was the main complication in the PBEN group and abdominal distension was the main complication in the IPEN group for post-pyloric feeding critical ill patients.Peptide-based enteral nutrition could repair the intestinal barrier function of post-pyloric feeding critical ill patients and increase the adaptability of gastrointestinal tract in the initial stage of enteral nutrition.
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To explore the effect of post-pyloric feeding by spiral nasoenteric tubes on ventilator-associated pneumonia (VAP) in neurocritical care patients. Methods A retrospective study was performed to analyze the clinical data of 175 neurocritical care adult patients with mechanical ventilation (MV) more than 48 hours, who were enrolled in three randomized controlled trials (RCT) conducted by Guangdong Provincial People's Hospital for post-pyloric tube placement between April 2012 to March 2019. The following patient clinical data were collected when patients were enrolled: gender, age, neurologic diagnosis, comorbidities, medication, endotracheal reintubation, bronchoscope treatment, the distal site of nasoenteric tubes, and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score, Glasgow coma scale (GCS) score, and acute gastrointestinal injury (AGI) grade assessed. Patients were divided into VAP group and non-VAP group according to the occurrence of VAP, and the differences of each index between the two groups were compared. Then the influencing factors of P < 0.1 were included in multivariate Logistic regression analysis to identify the potential risk factors affecting the incidence of VAP. Furthermore, patients were divided into gastric feeding group and post-pyloric feeding group according to the distal site of nasoenteric tubes, and subgroup analysis was performed to evaluate the variety of VAP in patients with different tube sites and status. Results ① Forty-two patients occurred VAP in 175 MV patients, and the incidence of VAP was 24.0%. ② Univariate analysis showed the P value of post-pyloric feeding, APACHE Ⅱscore, GCS score and bronchoscope treatment were less than 0.1, and post-pyloric feeding and GCS score in VAP group were significantly lower than those in non-VAP group [post-pyloric feeding: 19.0% (8/42) vs. 36.8% (49/133), GCS:5 (3, 7) vs. 6 (4, 9), both P < 0.05]. Multivariate Logistic regression analysis indicated that post-pyloric feeding was independent protective factor [odds ratio (OR) = 0.360, 95% confidence internal (95%CI) = 0.151-0.857, P = 0.021] and bronchoscope treatment was the independent risk factor (OR = 2.210, 95%CI = 1.051-4.647, P = 0.036) for VAP. ③ The incidence of VAP was 28.8% (34/118), 0% (0/4), 8.3% (1/12), 26.7% (4/15), 22.2% (2/9) and 5.9% (1/17) respectively when tube tip in stomach, D1, D2, D3, D4 and jejunum confirmed by abdominal radiography. Post-pyloric feeding in each proportion seemed to present lower VAP rate compared with gastric feeding, however, no significant difference was found (all P > 0.05). ④ The incidence of VAP in post-pyloric feeding group was significantly lower than that in gastric feeding group [14.0% (8/57) vs. 28.8% (34/118), OR = 0.403, 95%CI = 0.173-0.941, P = 0.032]. Lower VAP rate appeared on patients with SOFA < 12 (OR = 0.392, 95%CI = 0.154-0.995, P = 0.044) and AGI grade ≥Ⅱ (OR =0.086, 95%CI = 0.011-0.705, P = 0.006) fed by post-pyloric route according to the result of subgroup analysis stratified by age, gender, APACHEⅡ score, SOFA score and AGI grade. Conclusion Post-pyloric feeding would decrease the incidence of VAP in neurocritical care patients on MV.
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Objective@#To summarize the experience of naso pyloric posterior blind feeding tube and the application value and nursing strategy of gastric fluid reinfusion technique in critically ill patients.@*Methods@#A total of 100 patients with gastroduodenal retention were selected from February 2016 to April 2018 in our hospital. The gastrointestinal dysfunction was classified as class II to grade II, and the daily gastrointestinal decompression amount was more than 500 ml as the research object. All the 100 patients were treated with nasal blinded pylorus tube and were randomly divided into two groups. Based on prevention/control infection and organ function support protection and so on, the self-made modified closed autologous gastric juice retransfusion system was used for enteroenteroenteral retransmission and enteral nutrition treatment, while the patients in the control group only carried out enteral nutrition and did not carry out gastric juice transfusion. The indexes of the patients during the treatment of gastric juice were monitored, including water electrolyte disturbance and acid-base balance disorder, the time required for the total enteral nutrition, the imbalance of intestinal flora, the average number of gastric fluid return and the feeding intolerance, etc., and the complications and the complications during the process of the gastric juice transfusion were recorded. The success rate of nutrient tube after blind pylorus pylorus was analyzed and its causes were analyzed.@*Results@#After naso pylorus pylorus, the success rate of the nutrient tube was 91%. The main reasons for failure included the patients is intolerant of nutrient tube and limited body position. There were no statistical difference in the incidence of dysbacteriosis, aspiration and primary metabolic acid-base disturbance between the experimental group and the control group (P>0.05). In the experimental group, the number of patients with serious electrolyte disturbance, feeding intolerance and the number of days required to achieve total enteral nutrition, and the average number of days required for gastric juice transfusion were 1, 6, 5, (5.74±1.42)d, respectively, were significantly less than those in the control group of 8, 15, 19, (13.94±3.53) d, with statistically significant differences (χ2=-15.239-7.294, P <0.05 or 0.01).@*Conclusions@#In the patients with ICU, it is easy to operate, easy to master, and to reduce the incidence of internal environment disorder and feeding intolerance, which is suitable for clinical popularization.
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Objective To summarize the experience of naso pyloric posterior blind feeding tube and the application value and nursing strategy of gastric fluid reinfusion technique in critically ill patients. Methods A total of 100 patients with gastroduodenal retention were selected from February 2016 to April 2018 in our hospital. The gastrointestinal dysfunction was classified as class II to grade II, and the daily gastrointestinal decompression amount was more than 500 ml as the research object. All the 100 patients were treated with nasal blinded pylorus tube and were randomly divided into two groups. Based on prevention/ control infection and organ function support protection and so on, the self-made modified closed autologous gastric juice retransfusion system was used for enteroenteroenteral retransmission and enteral nutrition treatment, while the patients in the control group only carried out enteral nutrition and did not carry out gastric juice transfusion. The indexes of the patients during the treatment of gastric juice were monitored, including water electrolyte disturbance and acid-base balance disorder, the time required for the total enteral nutrition, the imbalance of intestinal flora, the average number of gastric fluid return and the feeding intolerance, etc., and the complications and the complications during the process of the gastric juice transfusion were recorded. The success rate of nutrient tube after blind pylorus pylorus was analyzed and its causes were analyzed. Results After naso pylorus pylorus, the success rate of the nutrient tube was 91%. The main reasons for failure included the patients is intolerant of nutrient tube and limited body position. There were no statistical difference in the incidence of dysbacteriosis, aspiration and primary metabolic acid-base disturbance between the experimental group and the control group (P>0.05). In the experimental group, the number of patients with serious electrolyte disturbance, feeding intolerance and the number of days required to achieve total enteral nutrition, and the average number of days required for gastric juice transfusion were 1, 6, 5, (5.74±1.42)d, respectively, were significantly less than those in the control group of 8, 15, 19,(13.94±3.53)d, with statistically significant differences (χ2=-15.239-7.294, P <0.05 or 0.01). Conclusions In the patients with ICU, it is easy to operate, easy to master, and to reduce the incidence of internal environment disorder and feeding intolerance, which is suitable for clinical popularization.