营养支持在心脏外科术后体外膜肺氧合病人应用的临床观察

The clinical observation of enteral nutrition in adults receiving extracorporeal membrane oxygenation after cardiac surgery procedure

目的：观察营养支持对心脏手术后循环衰竭接受体外膜肺氧合（ECMO）辅助病人的耐受性和安全性. 方法：回顾性分析2009 ～ 2013年间在我院心外科ICU使用ECMO辅助的病人,所有的病人均因为心脏术后发生严重的心功能衰竭接受了VA-ECMO（venoarterial,VA静脉-动脉）辅助治疗,同时采用104.6 kJ（25 kcal）/（kg＆#183;d）肠内营养（EN）支持,共7d.营养耐受情况以达到喂养目标的达标率和观察胃潴留量为主.观察其安全性以EN引起的不良反应来评估. 结果：共有12例病人进行了ECMO辅助,EN为唯一的营养支持方式,所有病人第1周内营养耐受率超过70％.无一例出现EN引起的严重不良反应. 结论：接受ECMO辅助的危重症病人给予EN治疗安全、可行,无严重并发症,第1周内EN耐受率达70％.

Objective： Eenteral nutrition （EN） is considered controversial in critically ill patients with severe hemodynamic failure. To evaluate the tolerance and safety of EN in a consecutive group of pa- tients receiving venoarterial （VA） extracorporeal membrane oxygenation （ECMO） for severe hemody- namic failure. Methods： Retrospective observational study was performed in a cardiac surgical inten- sive care unit （ICU） during last 5 years. All adult patients receiving VA ECMO for severe hemodynamic failure unresponsive to conventional therapies were included. Nutrition support was enteral nutrition pro- tocol. Nutrition tolerance was defined as the ratio of delivered nutrition to target nutrition, expressed as a percentage. Special interest was made to detect possible adverse effects attributable to EN. Results： There were 12 patients treated with ECMO. EN was the only nutrition source. More than 70% nutrition tolerance was achieved within the first week in all cases. No serious adverse events that could be attribut- able to EN were noted. Conclusion ： Early EN is possible and safe in patients with severe hemodynamic failure receiving VA ECMO.