肠内营养支持治疗在危重症机械通气病人中的临床应用

Clinical application of enteral nutrition in critically ill patients with mechanical ventilation

目的:探讨肠内营养(EN)支持治疗对危重症机械通气病人营养状态和预后的影响。方法:采用随机对照法,将81例危重症病人分成治疗组和对照组。治疗组43例病人于机械通气后48 h内开始行EN支持治疗,对照组38例病人应用肠外营养(PN)支持治疗,并在肠功能改善后,逐渐过渡至流食和软食。观察两组病人的临床疗效,并监测治疗前和治疗后第7和第14天的血清清蛋白(ALB)、前清蛋白(PA)、免疫球蛋白(IgA)、血红蛋白(Hb)、氮平衡(NB)以及APACHEⅡ评分,呼吸机相关性肺炎发生率、2周内撤离呼吸机的成功率、机械通气时间以及入住ICU时间。结果:治疗组病人治疗第14天后,血清PA水平与治疗前和对照组比均有显著性差异(P<0.05)。血清ALB、IgA、NB明显高于对照组(P<0.05),APACHEⅡ评分显著低于对照组(P<0.05)。治疗组病人并发呼吸机相关性肺炎、机械通气时间和入住ICU的时间明显低于对照组(P<0.05)。2周内撤呼吸机成功率明显高于对照组(P<0.05)。结论:EN支持治疗有助于改善危重症机械通气病人的营养状况和预后。

Objective ： To investigate the treatment of enteral nutrition support in critically ill pa- tients with mechanical ventilation. Methods： Uusing randomized controlled methods,81 cases of criti- cally ill patients were divided into enteral nutrition support therapy group（ EN, treatment group）and par- enteral nutrition group（ PN, control group）. The clinical efficacy of two groups serum albumin, prealbu- min,immunoglobulin IgA, hemoglobin （Hb） , nitrogen balance and APACHE 1] score, the incidence of VAP within 2 weeks, the success rate of weaning, mechanical ventilation and ICU stay time were com- pared. Results： After the treatment, serum prealbumin levels, serum albumin, immunoglobulin IgA and nitrogen balance were significantly higher in EN group than those in the control group （ P 〈 0.05 ）. APACHE II score was significantly lower in EN group than that of the control group （ P 〈 0.05 ）. The ventilator-associated pneumonia, mechanical ventilation time,length of stay in ICU were significantly lower in EN group than those in the control group （ P 〈 0.05 ）. Conclusion ： In the mechanical ventilation patients, enteral nutrition support is helpful to improve the nutritional status and prognosis.