早期肠内营养对机械通气患者营养状态和预后的影响

The effect of early enteral nutrtion on the nutritional status and prognosis of patients with mechanical ventilation

目的评价早期肠内营养对机械通气患者营养状态和预后的影响。方法选择我院ICU机械通气患者65例,筛选出符合条件的33例,随机分为两组:早期肠内营养(EEN)组18例和早期完全胃肠外营养(TPN)组15例,在摄入相当热量和氮量的情况下,比较两组治疗前后营养状态、1周内撤机成功率、呼吸机相关性肺炎(VAP)发生率、平均营养费用及机械通气(MV)时间、平均住院天数。结果 2周治疗后EEN组血清总蛋白、清蛋白、血红蛋白水平和氮平衡较治疗前明显升高(分别P<0.05),且均高于TPN组治疗后水平(分别P<0.05)。上臂肌围、肱三头肌皮褶厚度两组对比无差异(P>0.05)。EEN组1周内撤机成功率明显高于TPN组(P<0.05),机械通气时间、平均住院天数则明显低于TPN组(分别P<0.05)。两组1周内VAP发生率比较差异无统计学意义(P>0.05)。结论早期肠内营养能改善机械通气患者的营养状况和预后。只要胃肠道功能正常,应尽早实施肠内营养支持。

Objective To evaluate the effect of early enteral nutrition on the nutritional status and prognosis of patients with mechanical ventilation.Methods 33 patients with mechanical ventilation in our ICU were randomly divided into two groups：the early enteral nutrition（EEN） group（18 cases） and the total parenteral nutrition（TPN） group（15 cases）.With considerable energy and nitrogen intake,the two groups were compared with nutritional status,success rate of the withdrawal of the me-chanical ventilation（MV） within one week,occurrence of ventilation associated pneumonia（VAP）,average nutritional costs,average mechanical ventilation（MV） time and average time of the hospital stay.Results After two weeks the post-treatment levels of serum total protein,serum albumin,hemoglobin and nitrogen balance in patients of the EEN group elevated obviously（P0.05,respectively） and were significantly higher than those of the TPN group at same stage（P0.05,respectively）.No difference was observed in the thickness of skin fold at musculus triceps branchii and muscular perimeter of the arm between the two groups（P0.05）.The success rate of the withdrawal of the mechanical ventilation（MV） within one week was significantly higher than that of the TPN group（P0.05） whereas the MV time,mean time of hospital stay and mortality of the EEN group were significantly lower than those of the TPN group（P0.05,respectively）.There were no difference in the occurrence of VAP between the two groups（P0.05）.Conclusion Early enteral nutrition can improve the nutritional status and prognosis of patients with mechanical ventilation.Enteral nutrition support should be given as early as possible if the enteral function is normal.