早期进食对降低急诊冠状动脉介入治疗后患者消化道并发症的作用

Effect of early foodintake on reducing gastrointestinal complications after emergent percutaneous coronary intervention in patients with acute myocardial infarction

目的探讨急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后早期进食与延迟进食对急性心肌梗死(acute myocardial infarction,AMI)患者早期消化道并发症和相关因素的影响。方法对因AMI接受急诊PCI治疗的患者197例按电脑数字随机法分为早期进食组(n=94)和延迟进食组(n=93),分别于PCI治疗后即刻或术后6 h开始进食,比较两组住院期间病死率、消化道出血、胃肠道不适、5 d内血清白蛋白浓度及电解质浓度变化、静脉用药总费用和住院总天数。结果除既往有消化道不适病史者早期进食组略高于延迟进食组外[31.9%(30/94)vs.17.2%(16/93),P<0.05],余基线资料两组间比较,差异无统计学意义(P>0.05)。早期进食组的消化道出血[2.1%(2/94)vs.8.6%(8/93),P<0.05]、上消化道不适[4.2%(4/94)vs.16.1%(15/93),P<0.05]及血清白蛋白浓度下降幅度[(-2±3)g vs.(-5±2)g,P<0.05]、5 d内的静脉用药总费用[(1 386±1 056)元vs.(1 558±1 269)元,P<0.05]和住院天数[(7±3)d vs.(9±4)d,P<0.05]显著低于延迟进食组,差异有统计学意义;电解质紊乱发生率早期进食组亦低于延迟进食组,但差异无统计学意义(P>0.05)。结论急诊PCI治疗后患者早期进食有助于减少消化道并发症、改善营养状态并降低静脉用药费用和缩短住院时间。

Objectives To investigate the effects of early and delayed foodintake after emergent percutaneous coronary intervention（PCI） on gastrointestinal complications and the related factors in patients with acute myocardial infarction（AMI）.Methods Totally 197 patients who underwent emergent PCI after AMI were randomized into early foodintake group（n=94） or delayed foodintake group（n=93） to intake food immediately or 6 hours after PCI respectively.The rates of death,gastrointestinal bleeding and digestive tract discomfort,changes of plasma albumin and electrolytes,cost of intravenous medications within 5 days after PCI and the length of stay in hospital were campared between the two groups.Results Baseline data were compatible between the two groups except that the rate of digestive tract discomfort was little higher in early foodintake group than in delayed foodintake group[31.9%（30/94） vs.17.2%（16/93）,P 0.05].The rates of gastrointestinal bleeding [2.1%（2/94） vs.8.6%（8/93）,P0.05],digestive tract discomfort [4.2%（4/94） vs.16.1%（15/93）,P 0.05],decrease of plasma albumin [（-2±3）g vs.（-5±2）g,P 0.05] and the cost of intravenous medications within 5 days after PCI[（1386±1056）yuan vs..（1558±1269）yuan,P 0.05]were significant lower and the length of stay in hospital was remarkable shorter [（7±3）d vs.（9±4）d,P0.05] in early foodintake group than in delayed foodintake group.Conclusions Early foodintake after emergent PCI benefits to reduce gastrointestinal complications,improve nutritional status and decrease the cost of intravenous medications as well as shorten the length of stay in hospital.