早期肠内营养支持对机械通气患者的辅助治疗作用

Effect of early enteral nutrition on mechanically ventilated patients

目的 观察早期肠内营养（EEN）支持对ICU机械通气患者的辅助治疗作用.方法 机械通气时间大于1周的患者47例,随机分为EEN组（n=24）和对照组（n=23）.EEN组入住ICU后12 ～24 h给予肠内营养（EN）,对照组入住ICU后72h～5 d给予EN,利用双糖试验法（乳果糖/甘露醇,L/M）测定两组患者肠黏膜屏障功能,观察患者体质量指数、体温、L/M比值、血清白蛋白、前白蛋白、脱机时间等临床指标.结果 入住ICU第7天时EEN组L/M为0.036±0.004,而对照组为0.108±0.020,EEN组明显低于对照组（t=2.746,P＜0.01）.EEN组平均体温（38.25±1.20）℃,低于对照组（38.92±1.40）℃（t=2.683,P＜0.05）便秘腹泻不良反应发生率[16.7％（4/23）与27.3％ （6/22）]及2周脱机成功率[90％ （18/20）与80％ （16/20）]好于对照组（x2值分别为5.36、6.08,均P＜0.05）；营养状态血清白蛋白、前白蛋白水平也较对照组有增高趋势.结论 早期应用肠内营养支持对呼吸机辅助通气患者能改善肠黏膜屏障,提高脱机成功率.

Objective To observe the effectiveness of early enteral nutrition （EEN） in managing ICU mechanically ventilated patients.Methods Totally 47 patients who had been ventilated for more than one week were randomly divided into EEN group and control group.The EEN group was supplied with enteral nutrition （EN） 12-24 hours after ICU admission,whereas the control group received EN 72 hours-5 days later.The function of intestinal mucosal barrier was evaluated by the reabsorb concentration of disaccharides lactulose/mannitol （L/M）.In addition,the body mass index （BMI）,body temperature,urine L/M ratio,serum albumin,pre-albumin,and ventilation days were recorded or calculated.Results On the seventh day,the L/M ratio was （0.036 ±0.004） in the EEN group,which was significantly lower than that （0.108 ±0.020） in the control group （t =2.746,P 〈0.01） ; the average body temperature was significantly lower in the EEN group than in the control group [（38.25 ± 1.20） ℃ vs （38.92 ± 1.40） ℃ ; t =2.683,P 〈 0.05）] ; the incidences of adverse reactions such as constipation and diarrhea were significantly lower in the EEN group [16.7% （4/23） vs 27.3% （6/22）,P〈0.05].The weaning rate within 2 weeks also favoured the EEN group [90% （18/20） vs 80% （16/20）,P 〈 0.05].Compared with the control group,the nutritional status of serum albumin and pre-albumin also showed a favourbale trends in the EEN group.Conclusions EEN can improve intestinal mucosal barrier and increase the weaning possibility in patients with mechanical ventilation.