序贯肠内营养治疗对老年危重症病人的营养支持效果

Effect of the program of sequential enteral nutrition on critically ill geriatric patients

目的：观察以短肽、短肽与整蛋白混合、整蛋白配方序贯调整的肠内营养（EN）方案对老年危重症病人的营养支持效果。方法：将94例老年危重症病人随机分为两组，即对照组45例，采用整蛋白配方，浓度、剂量、滴速均按常规方法逐渐调整增加；研究组49例，第1、2天给予短肽配方百普素，3d后给予短肽与整蛋白混合液（百普素与能全力），持续几天后逐渐过渡至完全整蛋白配方。两组必要时均以肠外营养（PN）补充以达到目标供给量。比较两组病人治疗前和治疗后第7、14天胃肠道并发症的发生率、营养状况、C-反应蛋白（CRP）、APACHEⅡ评分、胃肠功能评分以及14～28d内的病死率等。结果：研究组病人胃肠道并发症的发生率较对照组显著降低。治疗14d时，两组病人的前清蛋白、转铁蛋白、CRP、APACHEⅡ评分、胃肠功能评分等均较治疗前显著改善。研究组病人治疗7d时前清蛋白较对照组显著升高，14d时差异更加明显。研究组病人治疗14d时转铁蛋白较对照组明显升高，治疗7d时CRP较对照组明显下降，治疗14d时差异更加明显。研究组病人治疗14d时，APACHEⅡ评分、胃肠功能评分均较对照组显著降低，病死率较对照组有所下降。结论：以短肽、短肽与整蛋白混合、整蛋白配方序贯调整的EN方案，能显著地改善ICU老年危重症病人的营养状况和胃肠功能，有利于改善预后。

Objective： To observe the effect of peptide formula, mixed formula of short peptide and integrin, sequential EN program on critically ill geriatric patients in ICU. Methods： With random number table,94 patients were randomly divided into the control group and research group. Nutritional status, gastrointestinal complication rates, C-reactive protein （CRP）, APACHE 1I score, gastrointestinal function score before the treatment and 7d and 14d after the treatment as well as the sequelae were compared. Results： The incidence of gastrointestinal complications in the reserch group significantly reduced. PA, TF, CRP, APACHE Ⅱ score and gastrointestinal function score of the reserch group significantly improved. Conclusion： The sequential EN program can significantly improve the critically ill geriatric patients＇nutrition and gastrointestinal function.