营养支持治疗在老年危重患者救治中的应用

Application of nutrition support therapy in critically ill elderly patients

目的探讨不同营养支持方式在老年危重患者救治中的作用。方法选择老年危重患者98例,根据不同营养支持方式分为肠外营养(PN)组30例,肠内营养(EN)组32例,PN+EN组36例。摄入同等总热量和同等氮量,营养支持治疗时间>14 d。治疗0 d和连续营养支持治疗14 d后,检测血清白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb)、淋巴细胞总数(TLC)、免疫球蛋白(IgA、IgG、IgM)值并进行回顾性对比分析。结果 3组患者Hb均较治疗前增高。EN+PN组患者Alb、PA较PN组及EN组治疗后增高。营养支持治疗后,3组患者TLC明显增高。EN组IgA、IgM,EN+PN组IgA、IgG、IgM均较PN组增高。PN+EN组并发症低于PN组及EN组。结论老年危重患者救治中应根据老年人特点及疾病不同情况合理选择营养支持方式,PN+EN联合应用更有利于改善老年危重患者营养状况及免疫功能,减少并发症发生,促进疾病的康复。

Objective To investigate the clinical efficacy of nutrition support with different pathways in critically ill elderly patients. Methods Ninety-eight cases of hospitalized critically ill elderly patients were enrolled. They were divided according to different nutrition support pathways into parenteral nutrition group（PN）（30 cases）,enteral nutrition group（EN）（32 cases） and parenteral plus enteral nutrition group（PN ＋ EN）（36 cases）. All patients received the same total calories and the same amount of nitrogen. Duration of nutrition support was 14 d. The serum albumin（Alb）,prealbumin（PA）,hemoglobin（Hb）,total lymphocyte count（TLC）,immumoglobin（IgA,IgG,IgM） were determined on day 0 and day 14 after treatment. The results were analyzed retrospectively. Results After nutrition support for 14 day,levels of Hb in three groups were elevated. Alb,PA in EN ＋ PN group were increased significantly than those in EN group. TLC were significantly increased in the three group. IgA,IgM in EN group,also IgA,IgG,IgM in PN ＋ EN group were higher than those in PN group. The incidence of complications was lower in PN ＋ EN group than that in PN group or EN group. Conclusions For critically ill elderly patients,pathways of nutrition support will be considered. PN ＋ EN nutrition support manner may be suitable in ameliorating nutritional status,improving immune function and decreasing incidence of complications.