頁籤選單縮合
題名 | 嚴重急性頭部外傷病患的腸道營養照顧:早期不同管灌餵食方法的可行性和比較 |
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作者姓名(中文) | 黃淑俐; 李石增; | 書刊名 | 中華民國營養學會雜誌 |
卷期 | 18:1/2 民82.05 |
頁次 | 頁87-98 |
分類號 | 416.21 |
關鍵詞 | 嚴重急性頭部外傷病患; 腸道營養照顧; 管灌餵食方法; Continuous feeding; Bolus feeding; Gastric residue volume; |
語文 | 中文(Chinese) |
中文摘要 | 本研究以48個嚴重頭部外傷病患為對象,觀察住院後或手術後第一天到一過之內對不同的管灌方法與餵食頻率的實際接受度,以及體位測量值和生化檢驗值的改變。以隨機的方式將其分做三組,均給予熱量:氮=150:1,2大卡/毫升的營養配方,能在入院後或手術後24小時內即開始由鼻胃管餵食。第一組每4小時以空針筒餵食250毫升開始持續一天,第二天以後改為每天4次、每次350毫升的方式繼續。第二組第一天以每2小時空針筒餵食120毫升開始,第二天以後繼續第一組的餵食步驟。第三組第一天則以連續性餵食控制器給予50毫升/小時,第二天以後繼續進行第二組的餵食步驟。餵食前反抽胃餘容積,如果大於100毫升,則將每4小時餵食方式改為每2小時,每2小時改為連續性餵食,而連續性餵食則改為禁食。觀察結果,第一天三組分別有4、6、4個病人不能適應當天的餵食方式;一過後,三組各有7(44)-7(44)-9(56)人能順利進行餵食計劃。三組適應良好的病人(23人)與適應不良的病人(13人),攝取熱量與蛋白質、體重變化與氮平衡一週後有顯著的差異(p<0.01);且均無吸入性肺炎的情形發生。本研究結果證實,對急性期的嚴重頭部外傷病患,機動性的調整灌食方法,使受傷後能接受腸道營養並儘早達到預估需要營養量。此積極的營養供給以維持病患的營養狀況,雖無固定的方法可循,乃依實際臨床狀況而異,且早期的腸道營養應是無害並具有其可行價值。 |
英文摘要 | Forty-eight acute head injury patients with deep coma were randomized intoan enteral nutritional study for one week. The objectives of this study were to compare the efficacy of methods and intervals with early enteral feeding insevere head injury patients. Tube feeding were administered following the protocols established for this study. All patients received enteral formula thatcontains 2 Kcal/ml. Tube feeding protocol were started within 24 hours on day1, Group I patients were fed with every 4 hours bolus feeding for 1 day then shifted to 350 ml four times daily, Group H patients with every 2 hours bolus feeding for I day then shifted to the method of Group I, Group III patients with continuous feeding 50 ml/hr for 1 day then shifted to the method of Group II. If the aspirated gastric residue volume more than 100 ml before fed, we changedevery 4 hours bolus feeding to every 2 hours bolus feeding, every 2 hours bolusfeeding to continuous feeding and continuous feeding to discontinuous state respectively. There were 4 in Group 1, 6 in Group II, 4 in Group III intolerated thecurrent feeding method on day 1. Seven in group 1, 7 in Group II) and 9 in Group III, total 23 patients, had good tolerance during the study. There weresignificant differences between the good tolerance (n = 23) and the intolerance (n= 13) patients in calorie intake, protein in take, body weight change and nitrogenbalance (p < 0.01), besides no one has aspiration pneumonia. These results suggest that early enteral feeding in acute severe head injurypatients were feasible and harmless. The tolerance to enteral feeding in acute stage can be individualized. Adequate nutritional support with different feeding methods should be depend on patient's clinical condition. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。