危重症患者肠内外营养作用的对比研究

Comparative study on effect of enteral and parentral nutrition in critically ill patients

目的探讨早期足量肠内外营养支持治疗对危重患者的重要作用及两者的疗效比较。方法选择我院重症监护室（ICU）2004年6月～2007年6月问（124）例危重症患者，随机分为肠内营养（EN）组、肠外（PN）组、混合营养组及对照组，前三组病人于入院24～48小时内开始予相应营养支持，同时均予其它综合治疗。观测各组病人人院10天治疗前后ALT、Cr、CK—MB、TNT、血总蛋白、白蛋白、前白蛋白、血红蛋白、呕吐物潜血等指标的变化。结果对照组血ALT、Cr、CK—MB、TNT明显高于EN组、PN组和混合营养组（P〈0．05），后三组治疗前后及组间ALT、cr均无显著性差异（P〉0．05）；EN组、混合营养组病人血白蛋白、前白蛋白、血红蛋白较之PN组和对照组升高明显（P〈0．05），而PN组较对照组亦有较明显升高（P〈0．05），EN组与混合营养组问无明显差异（P〈0．05）；对照组和PN组消化道出血发生率均为37％，明显高于混合营养组消化道出血发生率10．8％（P均〈0．05），以上三组又高于EN组的发生率6．45％（P均〈0．05）。结论重症患者及早给予营养支持治疗可以有效防止营养不良、免疫功能低下等情况的发生，EN比PN和单纯葡萄糖供能优势更加明显，有助于保护胃肠道和其他重要器官功能／防止肠道细菌及毒素移位／减轻全身炎症反应，防止多脏器功能不全发生。

Objective To evaluate the important effect on critically ill patients with early , full dosage enteral and parenteral nutrition treatment and the comparement of effects between those treatments. Methods During the June of this year, the 124 critically ill patients in the intensive care unit of our hospital were treated and randomly divided into enteral nutrition group, parentaral nutrition group, mixed nutrition group and control group. Within 24 - 48 hours after admission, the patients in first three groups were cured with correspond nutrition supply and other treatments. The change of every groups patients ＇ indexes, such as ALT,Cr,CK-MB ,TNT,TP,ALB ,PA, HGB and occult blood of vomit, were observed before and 10 days later after treatment. Results The indexes of ALT,Cr,CK-MB,TNT in control group were obviously higher than those in EN, PN and MIX groups （ P 〈 0.05 ）. There was not significant difference of ALT and Cr in the later three groups before and after treatment （ P 〉 0.05 ） , and there was not significant difference of ALT and Cr among these groups, also （P 〉 0.05 ）. The indexes of ALB, PA, HGB of patients in EN and MIX groups were more increased than those in PN and cantrol groups（P 〈0. 05）, and the indexes in PN group were higher than those in control group（P 〈 0. 05 ）, and there was not significant difference between EN and MIX groups（P 〈0. 05 ）. Incidence rate of alimentary tract hemorrhage in control and PN groups were 37%, which was higher than that in MIX group, 10.8%, （P 〈 0. 05 ）. Otherwise, all of them were higher than incidence rate,6. 45% ,in EN group（ P 〈 0. 05 ）. Conclusion Malnutrian ,low immune function, and so on could been effectively prevented with early nutrition supply on critically ill patients. The treatment with enteral nutrition has more advantage than that with parenteral nutrition or single glucose, which could protect gastrointestinal tract and other important organs,prevent displacement of bacteria and toxin ,release infection reaction of whole body and avoid MODS.