摘要：

目的 探讨床旁超声联合肠内营养耐受性评分指导老年出血性脑卒中患者营养支持治疗的效果。方法 采用随机数字表法将80例老年出血性脑卒中患者分为对照组（n=40）和研究组（n=40）。对照组根据肠内营养耐受评分指导肠内营养支持治疗。研究组根据床旁超声获取胃窦运动指数（motility index,MI）和胃残余量，根据MI和肠内营养耐受评分共同指导肠内营养支持治疗。比较两组患者7d肠内营养喂养热量、目标喂养达标率、肠内营养并发症情况以及入院时、住院第5天和第10天营养指标、美国国立卫生研究院卒中量表（national institute of health stroke scale,NIHSS）评分、格拉斯哥昏迷量表（Glasgow coma scale,GCS）评分。结果 研究组患者7d肠内营养喂养平均热量和7d内目标喂养达标率分别为（72.05±12.18）kJ/（kg·d）和90.0%，对照组分别为（60.74±14.92）kJ/（kg·d）和70.0%，研究组显著高于对照组（P<0.05）。研究组患者达目标喂养时间、喂养不耐受中断次数分别为（72.43±16.58）h和（1.75±0.35）次，对照组分别为（92.18±24.84）h和（3.17±0.85）次，研究组显著少于对照组（P<0.05）。研究组住院第5天和第10天时血清总蛋白（total protein,TP）、白蛋白（albumin,Alb）和前白蛋白（prealbumin,PA）水平均显著高于对照组（均P<0.05）。研究组住院第5天和第10天时NIHSS评分显著低于对照组，GCS评分显著高于对照组（均P<0.05）。研究组胃肠道并发症总发生率显著低于对照组（P<0.05）。结论 依据床旁超声联合肠内营养耐受性评分制定个体化肠内营养支持方案，能够显著缩短老年出血性脑卒中患者达目标喂养时间，减少肠内营养并发症，改善营养状态，减轻神经功能损伤，改善预后。

Abstract：

Objective To explore the effect of bedside ultrasonography combined with enteral nutrition tolerance score in guiding nutritional support therapy for elderly patients with hemorrhagic stroke. Methods A total of 80 elderly patients with hemorrhagic stroke were randomly divided into a control group and a study group, with 40 patients in each group. The control group received enteral nutrition support therapy guided by the enteral nutrition tolerance score. The study group received enteral nutrition support therapy guided by both the antral motility index(MI) and enteral nutrition tolerance score, with MI obtained via bedside ultrasonography along with gastric residual volume. The two groups were compared in terms of 7-d enteral nutrition feeding amount,target feeding rate and enteral nutrition complications, and nutritional indicators, the National Institutes of Health Stroke Scale(NIHSS) scores, and Glasgow coma scale(GCS) scores at admission and on the 5th and 10th day of hospitalization. Results The mean 7-day enteral nutrition feeding calorie intake and 7-day target feeding rate were(72.05±12.18) kJ/(kg·d) and 90.0%,respectively, in the study group, and(60.74±14.92) kJ/(kg·d) and 70.0%, respectively, in the control group, with significantly higher values in the study group(P<0.05). The target feeding time and feeding intolerance interruption times were(72.43±16.58) h and(1.75±0.35) times, respectively, in the study group, and(92.18±24.84) h and(3.17±0.85) times, respectively, in the control group,with significantly fewer values in the study group(P<0.05). The levels of serum total protein(TP), albumin(Alb), and prealbumin(PA) on the 5th and 10th days of hospitalization were significantly higher in the study group than in the control group(all P<0.05).The NIHSS scores on the 5th and 10th days of hospitalization were significantly lower, and GCS scores were significantly higher, in the study group than in the control group(all P<0.05). The overall incidence of gastrointestinal complications was significantly lower in the study group than in the control group(P<0.05). Conclusions Individualized enteral nutrition support program based on bedside ultrasonography combined with enteral nutrition tolerance score can significantly shorten the target feeding time, reduce enteral nutrition complications, improve nutritional status, alleviate neurological damage, and improve prognosis in elderly patients with hemorrhagic stroke.