| Background: Neurocritical care patients often have severe organic lesions in the nerve center resulting in impaired consciousness due to head trauma,intracerebral hemorrhage,and large cerebral infarction,and the body is often in a hypermetabolic,Hypercatabolic state,which,combined with the disease,is often accompanied by the loss of autonomous feeding ability,and the prognosis is often poor.Enteral nutrition has the characteristics of maintaining the normal physiological function of digestive system,therefore,timely and effective nutritional support is particularly important to improve the nutritional status and improve the prognosis of neurocritical care patients.At present,the commonly used enteral nutrition modalities in clinical practice include transnasogastric tube nutrition and jejunal nutrition,due to the long-term bed rest of neurocritical care patients,easy to experience reflux aspiration of gastric contents,leading to the occurrence of aspiration pneumonia,some experts believe that jejunal nutrition has unique advantages,but jejunal nutrition needs to be located under the ultrasound,has difficulty in operation and other deficiencies,The choice of enteral nutrition support mode in neurocritical care patients at home and abroad and its influence on patients’ safety and complications during nutrition are still controversial,combined with the fact that most previous studies were retrospective studies and the baseline data of patients with two different nutrition support modes were different,the prognosis of nutrition support was also affected,so it is difficult to make a precise judgment about the difference in the efficacy of nasogastric tube nutrition and jejunal nutrition.This study intends to apply propensity score matching(PSM)to minimize the baseline difference between two groups of patients with different nutritional support in order to circumvent the interference of confounding factors and thereby clarify the influence of nutritional support mode.Aimed to analyze the effect of nasogastric tube nutrition versus jejunal nutrition support in neurocritical care patients and its effect on complications and prognosis,with the intention of providing new ideas and clinical basis for the selection of nutrition support in neurocritical care patients.Methods: The information of neurocritical care patients who were hospitalized and went through discharge in the Department of critical care medicine of our hospital from June 1,2020 to June 1,2022 was collected,and the clinical data included sex,age,comorbidities,admission diagnosis,whether craniotomy was performed,enteral nutrition mode,laboratory findings(hemoglobin,albumin,prealbumin,blood urea nitrogen),Patient vital sign scores(GCS,APACHE II)and outcome.According to the enteral nutrition support method,the whole included cases were divided into two groups,including the nasogastric tube nutrition group and jejunal nutrition group,and statistical analysis there were no significant differences in each baseline indicator between the two groups.PSM propensity score matching was used to balance the confounding bias between the two groups,and after matching,we again statistically analyzed whether there were any significant differences in each baseline indicator between the two groups.Based on the statistical charts drawn,differences in in-hospital complications,mortality,hospital costs,and mean length of stay between the two groups were compared to determine the effect of different nutritional support for neurocritical care patients.Baseline data and nutritional support were included in the univariate logistic regression analysis,the relevant factors affecting the patients’ death during hospitalization were initially screened,and the relevant indicators were subsequently included in the multivariate logistic regression analysis,to identify the independent risk factors and protective factors.Results: A total of 212 neurocritical care patients,who were hospitalized in our department,were excluded according to the exclusion criteria: 12 patients were contraindicated to enteral nutrition,8 patients had incomplete clinical data,4 patients had previous cranial surgery,and4 patients were younger than 18 years old.Finally,184 patients were included,121 in the nasogastric nutrition group and 63 in the jejunal nutrition group.The distributions of gender,neurocritical type,and diabetes mellitus were significantly different between the two groups before PSM matching(P < 0.05).After 1:1 matching using PSM,a total of 62 pairs were matched successfully,and there was no significant difference between each baseline indicator of two groups after matching.Statistical analysis no significant differences were observed in the occurrence of complications,mortality,length of ICU stay,total length of hospital stay or hospital costs between the two groups(P > 0.05),and further univariate and multivariate logistic analysis revealed that age(or = 1.04,P = 0.02),Acute physiology and chronic health score(APACHE II,or = 1.15,P < 0.01)and blood urea nitrogen level(or =0.87,P = 0.03)may be key prognostic factors in this category of patients.Conclusions: There were no significant difference in clinical outcomes between nasogastric and jejunal nutrition for neurocritical care patients,and older age,higher APACHE II,and blood urea nitrogen levels were independent risk factors for in-hospital mortality in neurocritical care patients. |
PDF Full Text Request