心脏大血管术后呼吸机脱机困难患者的营养支持治疗

Nutritional support treatment for patients with difficulty breathing machine off-line after heart and great vessels surgery

目的总结心脏大血管手术后呼吸机支持治疗患者营养支持的经验。方法回顾性分析本科近4年来29例呼吸机支持治疗≥72 h患者,采用肠外逐渐向肠内营养过渡,分阶段由低热卡逐步提高热卡支持治疗的治疗方案。结果 29例患者中7名患者死亡,其中3例死于严重感染,1例死于枕骨大孔疝,1例死于肾衰竭,2例死于术后低心排。无患者死于营养支持不当并发症。22例患者顺利脱离呼吸机后自主进食,并治愈出院。其中3例患者高血糖,调整胰岛素后即好转;7例患者出现鼻饲后腹泻,对症处理后好转;无患者出现高脂血症。结论心脏大血管外科手术后不能顺利脱机而不能正常进食的患者应采用肠外逐渐向肠内营养过渡,分阶段由低热卡逐步提高热卡支持治疗。

Objective To study the reasonable uses of the nutritional support treatment in severe patients of post heart operation during mechanical ventilation. Methods The nutritional sup- port treatment was performed in 29 cases of severe patients after heart operation during mechanical ventilation. All cases were supported from parenteral nutrition to enteral nutrition gradually. The energy supply was increased from low - calorie to high - calorie step by step. Results Seven cases died in 29 cases, 3 cases died of severe infection, 1 case died of magnum herniation, 1 case died of kidney failure and 2 cases died of postoperative low cardiac output. No patients died due to the out- break of complications. With proper nutrition support, 22 cases became less dependent on mechani- cal ventilation. Three cases with high blood sugar turned better after insulin adjustment. Seven cas- es had post- nasal feeding diarrhea and got improved after treatment. None of the patients had hy- perlipidemia. Conclusion Patients who cannot wean from mechanical ventilation and cannot eat normally after cardiovascular surgery should be gradually transited from parenteral to enteral nutri- tion in phases from low - heat to high - heat caloric support treatment