重症病人营养治疗的并发症

Complication of nutrition therapy for critically ill patients

重症病人肠外营养并发症包括机械并发症、感染并发症及代谢并发症。感染并发症在重症病人中更常见,与不易控制的应激性高血糖有关。高血糖是重症病人代谢特点之一,与肠外营养密切相关。重症病人肠内营养并发症中感染并发症与代谢并发症相对较少。最重要的感染并发症是吸入性肺炎,其相关风险因素包括低头部卧位、呕吐、胃内置管营养、格拉斯哥评分<9、胃食管反流疾病、镇静药与抑制蠕动药的应用等。胃肠道并发症常见,胃肠道并发症的原因复杂,应根据不同原因进行处理。

Parenteral nutrition is associated with mechanical, metabolic and infectious complications. Infections are not uncommon and are associated with refractory hyperglycemia caused by stress response. Hyperglycemia is one of the metabolism characteristics in critically ill patients. Patents performed enteral nutrition treatment have a relative low incidence of metabolic and infectious complications. One of the most important infectious complications is aspiration pneumonia. Risk factors that significantly correlated with pneumonia were low bed backrest, vomiting, gastric feedings, a Glasgow Coma Scale score 〈9, gastroesophageal reflux disease, high sedation level and the use of paralytic agents. Gastrointestinal complications are very common in enterally fed patients. The reasons causing gastrointestinal complications are complex, and medication should be based on different reasons.