Background: Patients with stroke suffer from nutrition impairments and often rely on enteral nutrition (EN), which is associated with respiratory complications such as regurgitation and aspiration.
Objective: To evaluate the incidence of regurgitation and aspiration in patients with severe stroke infused with different volumes of EN.
Methods: A randomized controlled trial was conducted on 210 patients with severe stroke undergoing EN therapy. Patients were randomly assigned into two groups. Subjects in the treatment group received EN with an initial rate defined according to the total volume and the infusion rate was adjusted based on gastric residual volume (GRV) assessed every 4 hours. Subjects of the control group received EN without monitoring the GRV and reached the target infusion volume within 72 hours. The incidence of reflux and aspiration was recorded.
Results: The incidences of regurgitation and aspiration were significantly lower in treatment group (6.3% and 7.9%, respectively) than control group (18.8% and 17.5%, respectively). In the treatment group, 1 patient developed regurgitation while 2 developed aspiration when EN was 500 mL. When EN increased to 1000 mL, 2 patients developed regurgitation and 2 developed aspiration, and 5 patients developed regurgitation and 6 had aspiration when EN was 1500 mL. There was no significant difference in the risk of reflux and aspiration when total volume of EN increased from 500 to 1500 mL.
Conclusions: During EN therapy for patients with stroke, using feeding pump with a continuous infusion for 20 hours and adjusting infusion rate based on GRV could reduce the incidence of respiratory complications.
背景：脑卒中患者容易伴发营养不良，通常依靠肠内营养（EN）来维持。但 肠内营养也存在反流和误吸等呼吸系统方面的并发症。目的：探讨重症脑卒中 患者在不同EN 输注总量之间反流及误吸风险的差异。方法：选择重症脑卒中 患者210 例进行随机对照研究，患者随机分为2 组：治疗组患者初始速度根据 EN 总量调节，输注过程中通过每4 小时测定胃残留量（GRV）的情况进行调 速。对照组患者不监测GRV，在72 小时内缓慢增速至EN 目标量。比较两组 患者反流和误吸的风险。结果：治疗组患者反流和误吸的发生率分别为6.3% 和7.9%显著低于对照组的18.8% 和17.5%。在治疗组中，500 mL 输注时有1 例患者发生反流和2 例患者发生误吸；当输注量增至1000 mL 时，2 例患者发 生反流，2 例患者发生误吸；1500 mL 输注时，5 例患者发生反流，6 例患者发 生误吸。EN 输注总量从500 mL 增至1500 mL 时，并未显著增加反流和误吸的 风险。结论：脑卒中患者EN 治疗过程中，采用以营养泵持续20 小时匀速输 注，初始速度按总量调节，输注过程中通过监测GRV 调整速度可显著减少呼 吸系统的并发症。.