重症患者动态营养变化与呼吸机相关性肺炎的发生相关性研究

Correlation study of dynamic nutritional changes in the occurrence of ventilator-associated pneumonia in critically ill patients

目的研究重症患者营养状态与呼吸机相关性肺炎(VAP)的关系。方法 58例机械通气患者分为VAP组23例和未发生VAP组35例,另选健康志愿者15例作为对照组。比较3组的血清前白蛋白(PA)、血清白蛋白(ALB)、血清转铁蛋白(TRF)、血清胆碱酯酶(ACHE)、淋巴细胞计数(TLC)及临床肺部感染评分(CPIS)、序贯器官衰竭估计(SOFA)评分。结果 VAP组入科48h时的PA、入科96h时的TLC及入科1周时的TFR、TLC均低于未发生VAP组,入科96h、1周时SOFA、CPIS评分均高于未发生VAP组,差异均有统计学意义(P<0.05)。结论营养不良的机械通气患者易发生VAP,可选半衰期较短的PA和TRF作为监测指标。早期积极地营养干预可能会降低VAP的发生率,改善已发生VAP的危重患者的预后。

Objective To study the correlation between nutritional status and ventilator-associated pneumonia（VAP） in critically ill patients.Methods 58 cases received mechanical ventilation were divided into VAP group of 23 and without VAP group of 35,another 15 health volunteers were chosen as the control group.PA,ALB,TRF,ACHE,TLC,CPIS and SOFA of 3 groups were compared.Results The PA 48 hours after hospitalization,TLC 96 hours after hospitalization and TFR one week after hospitalization of the VAP group were respectively lower than those of the without VAP group,while SOFA 96 hours,one week after hospitalization and CPIS of the VAP group was respectively higher than those of the without VAP group,and all the differences were statistically significant（P 0.05）.Conclusion Malnourished patients who received mechanically ventilation are more likely to occurr VAP.PA and TRF can be taken as the monitoring items.Early nutrition intervention may reduce the incidence rate of VAP,and improve the prognosis of critically ill patients with VAP.