临床营养支持模式与实施方法对成年急性重症患者近期临床结局的影响

Impacts of different nutrition support methods on short-term outcome in critically ill adult patients

目的 评估临床营养支持模式与实施方法对成年急性重症患者近期临床结局的影响.方法 回顾性分析1994年1月至2009年12月在海南省人民医院重症医学科收治的1503例成年急性重症患者的营养支持相关资料,比较不同营养支持模式与实施方法对营养支持并发症、患者在ICU停留时间、感染与多器官功能障碍综合征（MODS）发生率和病死率的影响.结果 所有患者营养风险筛查评分（NRS）均≥3分.早期肠内营养（EN）组患者在ICU的停留时间明显短于非早期EN组（P＜0.001）和肠外营养（PN）组（P＜0.001）,感染发生率（P均＜0.001）、MODS发生率（P均＜0.001）及病死率（P均＜0.001）也均明显低于非早期EN组和PN组患者.PN液中添加谷氨酰胺组患者在ICU停留时间明显短于未添加者（P=0.0000）,感染（P=0.0252）和MODS发生率（P=0.0030）及病死率（P=0.0305）均明显低于未添加者.强化胰岛素治疗组患者在ICU停留时间明显短于常规胰岛素治疗组（P=0.0000）,感染（P=0.0001）和MODS发生率（P=0.0237）及病死率（P=0.0427）均明显低于常规胰岛素治疗组.结论 重症患者普遍存在营养风险,需要给予营养支持.早期EN、PN液中添加谷氨酰胺及给予强化胰岛素治疗能够缩短患者在ICU停留的时间,降低感染和MODS发生率及病死率.

Objective To explore the impacts of different nutrition support methods on short-term outcome in critically ill adult patients. Methods We retrospectively reviewed the clinical data of 1503 critically ill adult patients who needed nutrition support in an mixed intensive care unit （ICU） of a tertiary care university hospital from January 1994 to December 2009. The complication of nutrition support, length of stay （LOS） in ICU, morbidity of infection and multiple organ dysfunction syndrome （MODS）, and mortality among different nutrition support methods were compared. Results The Nutritional Risk Screening （NRS） scores of the enrolled patients were no less than 3. LOS in early enteral nutrition （EN） patients were significantly shorter than those in not-early EN patients （P 〈 0. 001） and parenteral nutrition （PN） patients （both P 〈 0. 001）. Infection rate （P 〈 0. 001）,morbidity of MODS （P 〈 0. 001） and mortality （P 〈 0. 001） were significantly lower than those in not-early EN and PN patients. LOS of patients receiving PN rich in glutamine （Gln） was significantly shorter than that in conventional formula （P = 0. 0000）. Morbidity of infection （P= 0. 0252） and MODS （P = 0. 0030）, mortality （P =0. 0305） were significantly lower than that of conventional patients. LOS of patients receiving intensive insulin therapy （IIT） was significantly shorter than that of controlled group （P = 0. 0000）. Morbidity of infection （P =0. 0001） and MODS （P = 0. 0237） and mortality （P =0. 0427） were significandy lower than those of controlled group. Conclusions Nutritional risk is prevalent among critically ill adult patients. Early EN, PN of rich in Gln,and receiving IIT can shorten LOS, decrease morbidity of infection and MODS, and improve prognosis among these patients.