鼻饲患者应用营养泵对降低机械通气患者呼吸机相关性肺炎发生率的作用探讨

Effect of nutrition pump on the incidence of ventilator-associated pneumonia of mechanical ventilation for nasal feeding patients

目的探讨鼻饲患者应用营养泵对降低机械通气患者呼吸机相关性肺炎(Ventilator associated pneumonia,VAP)发生率的作用。方法选择2012年6月至2013年6月在我院收治的78例机械通气患者作为研究对象,将患者按照随机数字表法分成观察组和对照组,输入营养液成分一致,观察组采用持续24h肠内营养泵行鼻饲营养支持治疗;对照组采用50ml注射器间断推注营养液,3次/d。比较两组患者营养状态、胃内容物反流、口咽分泌物误吸、VAP的发生率及不良反应发生率情况。结果观察组患者营养状态(谷草转氨酶、血清白蛋白、血红蛋白及前白蛋白水平)明显优于对照组(t=4.230,7.348,4.592,6.916,P<0.05);观察组患者的胃内容物的反流率、误吸率及VAP发生率明显低于对照组(χ2=5.342,5.186,4.044,P<0.05);观察组患者的不良反应发生率明显低于对照组(χ2=7.86,5.64,4.13,4.52,P<0.05),差异有统计学意义。结论机械通气鼻饲患者应用营养泵输注可明显降低胃内容物反流率、口咽分泌物误吸率,降低患者VAP的发生率,减少腹胀、腹泻等胃肠道不良反应,同时有助于改善患者营养状态。

Objective To investigate the effect of nutrition pump on the incidence of ventilator-associated pneumonia of mechanical ventilation for nasal feeding patients. Methods 78 patients with mechanical ventilation in our hospital were selected as the research object,and they were randomly divided into the observation group and the control group. All patients were given the same nutrient solution,and the observation group used persistent 24 h enteral nutrition pump for nasal feeding nutrition support therapy while the control group used 50 ml syringe to discontinuously inject the nutrient solution,3 times / d. The nutritional status,reflux of gastric contents,oropharyngeal secretionsaspiration,the incidence of VAP and the incidence of adverse reaction were compared between the two groups.Results The nutritional status of the observation group was better than the control group（ P〈0. 05）. The gastric contents reflux,aspiration rate and the incidence rate of VAP significantly lower in the observation group than in the control group（ χ^2= 5. 342,5. 186,4. 044,P〈0. 05）. The incidence of adverse reaction was significantly lower in the observation group than in the control group（ χ^2= 5. 64,4. 13,7. 86,4. 52,P〈0. 05）. Conclusion The application of nutrition infusion pump can reduce the gastric contents reflux,oropharyngeal secretions aspiration rate,the incidence of VAP,bloating,diarrhea and other gastrointestinal adverse reaction.