危重症病人两种营养管的耐受性、安全性及吸入性肺炎发生率的比较

The tolerance and safety of nasogastric tube feeding and naso-jejunum tube feeding and incidence of aspiration pneumonia in ICU enteral nutrition patients

目的:比较接受肠内营养(EN)治疗的危重症病人对鼻胃管和鼻空肠管的耐受性、安全性及吸入性肺炎的发生率。方法:将入住ICU需要1个月以上EN的60例病人随机分为鼻胃管组和鼻空肠管组,每组30例。两组病人给予EN。检测治疗前和治疗后2、3和4周清蛋白(ALB)、前清蛋白(PA)、血肌酐(Scr)水平,监测病人各项胃肠道功能障碍指标和吸入性肺炎的发生率。结果:两组病人治疗后第2周ALB和PA明显高于治疗前(P<0.05),治疗至第4周接近正常水平。鼻胃管组病人恶心、呕吐、腹胀、腹泻、胃潴留、菌群失调等的发生率与鼻空肠管组无显著性差异。病人腹胀、腹泻症状与输注营养液的速度明显相关。两组病人吸入性肺炎发生率无显著性差异(P>0.05)。结论:EN可改善危重症病人的营养不良,应根据病人个体情况选择EN液的输注途径。

Objective： To compare the tolerance and safety of nasogastric tube feeding and naso-jejunum tube feeding and incidence of aspiration pneumonia in enteral nutrition patients.Methods： 60 ICU patients with enteral nutrition above 1 month were randomized into nasogastric tube feeding group and naso-jejunum tube feeding group.Patients were given Nutrison Fibre or Peptisorb.The levels of ALB,PA and Scr were detected every one week.The incidence of gastrointestinal tract disturbance and aspirated pneumonia was noted.Rerults： The incidences of gastrointestinal tract disturbance and aspiration pneumonia were not significantly different between the two groups（P〉0.05）.Conclusion： Enteral nutrition may improve the nutrition status.The naso-jejunum tube feeding has no advantage to nasogastric tube feeding in our patients.The route of enteral nutrition should be selected according to the individual condition and local nosocomial experience.