单中心家庭肠内营养支持应用情况分析

Clinical experience of patients with home enteral nutrition in a single center of China

目的:观察家庭肠内营养(HEN)支持病人营养状况的变化、并发症的发生率和处理情况。方法:选择1 348例行HEN支持的病人,记录病人的一般资料,家庭营养支持前后的体重、体质指数和机体组成等变化,分析病人并发症的发生率和处理情况。结果:HEN支持病人平均每月治疗费用明显低于住院治疗费用。使用EN支持的时间平均为(80.78±78.47)d,每天摄入营养的总热量占病人需要量的95%以上,其中83.8%的病人使用商品化的EN制剂,16.2%使用匀浆膳,存活率为96%。有36例病人因短肠综合征行HEN支持2个月后,体重、体质指数、无脂细胞群、上臂围、上臂肌围、体细胞群、细胞内液和细胞外液值均较HEN支持前明显增加。电话随访中常提到的问题有堵管、腹泻、导管脱出、导管断裂、PEG/J管口周围生长肉芽等,均得到及时的处理。结论:家庭营养支持无偿访视小组可通过个体化系统的营养评估和动态监测,帮助病人达到营养需要的摄入目标量,改善营养指标,降低并发症发生率,及时解决HEN支持出现的问题。

Objective：The changes of nutritional status,their complications and treatment were observed in home enteral nutrition（HEN） support patients of RIGS,PLA.Methods：1 348 cases were enrolled between 2003 and 2010 for HEN and the patient＇s general information,the changes of body weight,body mass index and body composition,incidence and treatment of complications were recorded.Results：1250 HEN patients were in their own expense（92.73%） and 98 cases were free（7.27%）.The mean time of enteral nutrition support was（80.78 ± 78.47）days and daily nutrition intake of total energy was（1436.99 ± 180.27）kcal,which accounted for 95% and more of patients＇ need.83.8% of HEN patients used commercial enteral nutrition and the survival rate was 96%.After two months of EN,their body weight,body mass index and fat-free cell group,upper arm,upper arm muscle wall,cell groups,intracellular and extracellular fluids were improved in 36 HEN patients with short bowel syndrome.Telephone follow-up for help in problems in HEN patients included 74 cases of tube occlusion,45 cases of diarrhea,4 cases of tube prolapse,3 cases of tube breakage and 6 cases of granulation around PEG/J tube opening.Conclusion：Home enteral nutrition patients were regularly assessed and the nutritional status monitored.The nutritional intake can meet the needs of the target amount of patients.Through training and regular follow-up,complication rate can be decreased,HEN may help to save the costs and promote the rehabilitation.