标题：重症脑梗死患者肠内营养误吸的影响因素与护理对策

      作者：王龙芳 1，唐雪花 2，张潇潇 3    安康市中心医院北院重症医学科 1、重症医学科 2、神经内科 3，陕西 安康 725000

      卷次： 2019年30卷16期

      【摘要】 目的 探讨重症脑梗死患者肠内营养误吸的影响因素，总结有效的临床护理措施。方法 选择安康市中心医院北院重症医学科于2016年1月至2019年1月期间收治的74例急性脑梗死患者为研究对象，根据是否误吸将患者分为误吸组(n=38)与无误吸组(n=36)，比较两组患者的年龄、性别、高血压史、吸烟史、糖尿病史和卒中史、发病部位，以及格拉斯哥昏迷评分(GCS)、美国国立卫生研究院卒中量表评分(NIHSS)等临床资料，分析患者肠内营养误吸的影响因素，总结护理措施。结果 误吸组患者的年龄平均为(70.5±12.3)岁，明显高于无误吸组的(66.4±13.5)岁，吸烟史、卒中史、GCS≤12分、NIHSS＞10分的比例分别为44.74%、57.89%、78.95%、44.74%，明显高于对照组的 25.00%、27.78%、50.00%、19.44%，差异均有统计学意义(P<0.05)；Logistic回归分析结果显示，年龄、卒中史、GCS评分、NIHSS评分是重症脑梗死患者误吸的独立危险因素(P<0.05)。结论 误吸是重症脑梗死患者肠内营养治疗的常见并发症，其发生与高龄、卒中史，以及昏迷、神经功能缺损程度重有关；临床上应针对上述影响因素采取有效的护理措施，以降低误吸的发生风险。
      【关键词】 重症脑梗死；肠内营养；误吸；吸入性肺炎；因素；护理
      【中图分类号】 R473.74 【文献标识码】 A 【文章编号】 1003—6350（2019）16—2167—03

Influencing factors of misinhalation in patients with severe cerebral infarction undergoing enteral nutritionsupport and nursing strategies.
WANG Long-fang 1, TANG Xue-hua 2, ZHANG Xiao-xiao 3. Department of Critical CareMedicine 1, Department of Critical Care Medicine 2, Department of Neurology 3, Ankang Central Hospital (North District),Ankang 725000, Shaanxi, CHINA
【Abstract】 Objective To explore the influencing factors of misinhalation in patients with severe cerebral in-farction undergoing enteral nutrition support, and to summarize effective clinical nursing measures. Methods A total of74 patients with acute cerebral infarction were selected as the research subjects, who were admitted to the Department ofCritical Care Medicine at Ankang Central Hospital (North District) from January 2016 to January 2019. According towhether misinhalation occurred, the patients were divided into misinhalation group (n=38) and non-misinhalation group(n=36). The clinical data were compared between the two groups, including age, gender, history of hypertension, historyof smoking, history of diabetes mellitus, history of stroke, location of onset, Glasgow Coma Score (GCS), and the Na-tional Institutes of Health Stroke Scale (NIHSS). The influencing factors of misinhalation were analyzed in patients un-dergoing enteral nutrition support, and the nursing measures were summarized. Results In the misinhalation group, theaverage age was (70.5 ± 12.3) years, which was significantly higher than (66.4 ± 13.5) years in the non-misinhalationgroup; and the proportion of smoking history (44.74% vs 25.00%), stroke history (57.89% vs 27.78%), GCS<12 (78.95%vs 50.00%) and NIHSS>10 (44.74% vs 19.44%) were significantly higher than those in the non-misinhalation group; alldifferences were statistically significant (P<0.05). Logistic regression analysis showed that age, stroke history, GCSscore, and NIHSS score were independent risk factors for misinhalation in patients with severe cerebral infarction.Conclusion Misinhalation is a common complication in patients with severe cerebral infarction undergoing enteralnutrition support, and its occurrence is related to the age, stroke history, and the degree of coma and neurological defi-cits. Clinically, effective nursing measures should be taken against the above-mentioned influencing factors to reduce therisk of misinhalation.
      【Key words】 Severe cerebral infarction; Enteral nutrition support; Misinhalation; Aspiration pneumonia; Factors;Nursing·护理·doi:10.3969/j.issn.1003-6350.2019.16.038