幽门下喂养改善老年危重患者喂养效果及并发症

Inferior pylorus feeding improved feeding effect and complications in the elderly patients with critical disease

目的探讨幽门上喂养与幽门下喂养对老年危重患者营养状况及喂养并发症的影响。方法选取老年ICU肠内营养患者75例,根据肠内营养途径分为幽门上喂养(38例)和幽门下喂养(37例)2组,对比分析开始肠内营养1月内2组达到目标营养剂量的时间,腹泻、腹胀、呕吐、误吸等并发症发生比例及血清前白蛋白、转铁蛋白改善情况。结果幽门上喂养组达到目标营养剂量的时间为(4.18±2.24)d,长于幽门下喂养组[(2.40±0.99)d],2组比较具有统计学差异(P<0.01)。幽门上喂养组共发生喂养相关并发症20例,其中腹泻2例,腹胀8例,呕吐6例,误吸4例;幽门下喂养组共发生喂养相关并发症6例,其中腹泻4例,腹胀2例,未发生呕吐、误吸。2组之间喂养相关并发症比较存在统计学差异(P<0.01)。幽门下喂养组喂养1月后血清前白蛋白水平较喂养前明显升高,且存在统计学差异(P<0.05)。结论在老年危重患者中,幽门下喂养较幽门上喂养更易达到目标营养剂量,且发生腹胀、呕吐及误吸的概率较低,值得临床推广。

Objective To investigate the effect of pylorus feeding and inferior pylorus feeding on nutrition status and feeding complications in the elderly patients with critical disease. Methods Seventy-five elderly patients with critical disease receiving enteral nutrition were divided into pylorus feeding group（ 38 cases） and inferior pylorus feeding group（ 37 cases）. The time to reach the goal of nutrition dose,the incidence of diarrhea,abdominal distension,vomiting,aspiration,and the levels of serum prealbumin,transferrin in the two groups were evaluated and compared. Results The time to reach the goal of nutrition dose in pylorus feeding group（ 4. 18 ± 2. 24 d） was significantly longer than that（ 2. 40 ±0. 99 d） in inferior pylorus feeding group（ P〈0. 01）. The incidence of feeding complications in pylorus feeding group,including diarrhea（ 2 cases）,abdominal distension（ 8 cases）,vomiting（ 6 cases）,aspiration（ 4 cases）） was significantly higher than that in inferior pylorus feeding group（ including 4 cases of diarrhea,2 cases of abdominal distension,P〈0.01）. After feeding,the serum level of prealbumin was significantly improved in the inferior pylorus feeding group（ P〈0. 05）. Conclusions In the elderly patients with critical disease,inferior pylorus feeding is easier to reach the goal of nutrition feeding dose,with low incidence rate of abdominal distention,vomiting and aspiration.