The Research Of The Nutrition Status And Enteral Nutritional Support Route In Neurological Patients

Objective：A retrospection of the percutaneous endoscopic gastrostomy patientsin Peking Union Medical College HospitalRetrospect and analyze the influence of percutaneous endoscopicgastrstomy (PEG) treatment to neurological patients in gender ratio,distribution of etiology, turnover, reason of death, and complications.A perspective research of screening the nutritional status andcompare two different kinds of methods of diet in NO.1Hospital ofJilin UniversityCompare incidence rate of nutritional risk, nutrition index, renalfunction, hepatic function, and complications between patients whoseGlasgow Coma Scale (GCS) are not more than8and those whose GCS aremore than8[5]. Appropriate patients are selected to be detected the rate ofsucceed in placing the NGT. Compare the influence of nutrient solutiondiet and semi-liquid diet in the nutritional condition, etiology,complications and prognosis.Methods:A retrospection of the percutaneous endoscopic gastrostomy patientsin Peking Union Medical College Hospital Retrospective analysis of72cases of neurological patients with PEGtreatment is performed, in which patients’ gender ratio, distribution ofetiology, turnover, reasons of death, complications are analyzed.A perspective research of screening the nutritional status andcomparing two different kinds of method of diet in NO.1Hospital ofJilin UniversityDivide the32admitted patients into2groups, one is whose GCS arenot more than8, and the other is whose GCS are more than8. Compareincidence rate of nutritional risk two times, as soon as they come tohospital and1week later. And the nutrition index, hepatic index, renalindex and complications are also compared when they come to the hospitaland a week later between patients whose GCS are not more than8andthose patients whose GCS are more than8.Divide another group of patients with NGT who satisfy the inclusionsinto Group A (nutrient solution diet) and Group B (semi-liquid diet)randomly, each group contains9patients. Group A is treated with nutrientsolution which is given1125kcal/d, with48g protein per day in the first3ds,and given1500kcal/d, with64g protein per day after3ds, while Group B istreated with semi-liquid diet which is given less than1125kcal/d, with notmore than32g protein per day in the first3ds, and given less than or morethan1500kcal/d, with more than or less than64g protein per day after3ds.The nutritional risk has been screened for three times per case, as soon as they come to the hospital,1week later and2weeks later. The rate ofsucceed in placing the NGT, nutrition index, immune index, hepatic index,renal index, Glasgow Outcome Scale (GOS), Rankin Scale, NonverbalPain scale (NVPS), and complications are detected at three periods, beforeintubation,1w after intubation and2w after intubation, are observed.Results:A retrospection of the percutaneous endoscopic gastrostomy patientsin Peking Union Medical College HospitalThose ages above80s have the largest number of29(40.3%). Allpatients are mainly suffered from cerebral thromboembolism of35(48.6%)and motor neuron disease of21(29.2%). The total number of patients is72,with63(87.5%) of whom are improved,9(12.5%)of whom die, whilemost of the dead cases of7(77.8%) are due to pneumonia.37cases aresuffered from complications.A perspective research of screening the nutritional status andcompare two different kinds of dietAmong the admitted32patients,3of patients whose GCS are not morethan8have the complications (33.3%), none of patients whose GCS aremore than8points have any complication, with p<0.05. At the time ofadmission, the calf girth of patients of GCS≤8is（36.0±1.1）cm, and is（34.8±1.3）cmof GCS>8, with p=0.032(<0.05).Thepotassiumionofthepatients of GCS≤8is3.61（3.35-3.89）, and is3.97(3.79-4.28) of GCS>8 1week later.2weeks later, the BUN of Group A is（7.1±2.8）, of Group Bis（4.3±1.4）, with p=0.017(<0.05). NRS-2002in Group B decreasessteadily, and rapidly in Group A.Conclusion:NGT is an efficient method which can support enough energy to theneurological patients. Nutrient solution diet can save nursing time but costmore. PEG with a longer tube time is recommended to the patients whoneed the nutritional support more than4weeks. Pneumonia is the mostcommon complication for PEG patients. PEG is a good and convenientway for home nursing because of its promotion of satisfaction of familymembers and nurses.