Effect of indwelling nasointestinal tube for enteral nutrition support in patients with severe craniocerebral trauma undergoing mechanical ventilation / 中华危重病急救医学

ABSTRACT

Objective To evaluate the effect of indwelling nasointestinal tube for enteral nutrition (EN) support on patients with severe craniocerebral trauma undergoing mechanical ventilation (MV). Methods A total of 100 severe craniocerebral trauma patients undergoing MV admitted to intensive care unit (ICU) of the 117th Hospital of People's Liberation Army from February 2015 to February 2017 were enrolled, and they were divided into nasogastric tube group in which the EN was fed by nasogastric tube and nasal jejunal feeding tube group (nasointestinal tube group) by random digits table, with 50 patients in each group. Blood urea nitrogen (BUN), hemoglobin (Hb), serum albumin (Alb), acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, Glasgow coma scale (GCS) score before and 10 days after treatment, duration of MV, hospitalization time, and the incidences of ventilator-associated pneumonia (VAP) and reflux wrong aspiration of the two groups were observed and compared. Results There was no statistically significant difference in BUN, Hb, Alb, APACHEⅡscore or GCS score before treatment between the two groups. Ten days after treatment, BUN and APACHEⅡ score in the nasointestinal tube group were significantly lower than those in the nasogastric tube group [BUN (mmol/L) 6.3±1.6 vs. 8.0±2.2, APACHEⅡscore 17.9±3.2 vs. 20.8±6.3, both P < 0.05], Hb, Alb, GCS score were significantly higher than those in nasogastric tube group [Hb (g/L) 125.9±19.7 vs. 113.5±19.6, Alb (g/L) 35.9±6.2 vs. 31.9±6.2, GCS score 9.7±1.9 vs. 8.2±5.7, all P < 0.05], duration of MV and hospitalization time were significantly less than those in the nasogastric tube group [duration of MV (days)14.7±3.4 vs. 17.5±2.9, hospitalization time (days) 15.4±5.6 vs. 19.2±7.3, both P < 0.05], and the complication rate in nasointestinal tube group was obviously lower than that in nasogastric tube group [10% (5/50) vs. 36% (18/50), P < 0.05]. Conclusion For patients with severe craniocerebral trauma treated with MV, the EN treatment by means of indwelling nasointestinal tube is helpful for the recovery of consciousness, improvement of nutritional indexes, reduction of incidences of complications such as reflux aspiration, etc. and shortening the course of disease, thus the method can obviously improve the patients quality of life.