早期肠内营养对高血压性脑出血患者医院获得性肺炎的影响

The effect of early enteral nutrition on hospital acquired pneumonia in patients with hypertensive cerebral hemorrhage

目的 探讨早期肠内营养（EN）对重症高血压性脑出血患者医院获得性肺炎（HAP）的临床价值.方法 将140例重症高血压性脑出血患者按随机数字表法分成治疗组和对照组,治疗组（70例）术后48 h开始EN支持.对照组（70例）术后第2天开始全胃肠外营养（TPN）支持.观察两组HAP发生率、HAP持续时间、肺部二重感染发生率、呼吸机使用率、呼吸机使用时间以及HAP病死率.结果 治疗组HAP发生率、肺部二重感染发生率、呼吸机使用率分别为30.0%（21/70）、12.9%（9/70）、35.7%（25/70）,显著低于对照组的47.1%（33/70）、27.1%（19/70）、47.1%（33/70）（P＜0.05）;治疗组HAP持续时间、呼吸机使用时间分别为（6.4±2.3）、（6.4±0.5）d,显著短于对照组的（15.6±2.1）、（11.4±0.3）d（P＜0.01或＜0.05）.治疗组HAP病死率（8.6%,6/70）显著低于对照组（18.6%,13/70）（P＜0.05）.结论 早期EN不仅能有效降低重症高血压性脑出血患者HAP和肺部二重感染的发生率,还可以降低呼吸机使用率,缩短呼吸机使用时间,最终缩短了HAP的治疗时间,降低了HAP的病死率.

Objective To investigate the clinical value of early enteral nutrition （EN） on hospital acquired pneumonia （HAP） in postoperative patients with severe hypertensive cerebral hemorrhage.Methods One hundred and forty postoperative patients with severe hypertensive cerebral hemorrhage were divided into treatment group （70 cases） and controll group （70 cases） by random digits table. The treatment group was given EN from the second day after operation, while the control group was given total parenteral nutrition （TPN）. The incidence and duration of HAP,the incidence of superinfection,the percent and duration of mechanical ventilation and the mortality rate of HAP was observed. Results The incidence of HAP, superinfection and using mechanical ventilation in treatment group [30.0% （21/70）, 12.9% （9/70）,35.7%（25/70）] were significantly lower than those in control group [47.1%（33/70） ,27.1%（19/70） ,47.1%（ 33/70 ）] （P 〈 0.05 ）. The duration of HAP and using mechanical ventilation in treatment group[（6.4 ± 2.3 ）,（6.4 ± 0.5 ） d] were significantly lower than those in control group [（ 15.6 ± 2.1 ）, （ 11.4 ± 0.3 ） d] （P 〈 0.01or 〈 0.05 ）. The mortality rate of HAP in treatment group was significantly lower than that in control group [8.6% （6/70） vs. 18.6% （13/70）,P 〈0.05]. Conclusion Early EN not only effectively decreases the incidence of HAP and superinfection,but also decreases the incidence of mechanical ventilation, shortens the duration of mechanical ventilation and decreases the mortality rate of HAP.