鼻肠管与鼻胃管营养预防呼吸机相关性肺炎效果对比分析

Effect comparison on preventing ventilator associated pneumonia by nasointestinal tube and nasogastric tube nutrition

目的探讨鼻肠管和鼻胃管营养预防呼吸机相关性肺炎(VAP)的效果。方法将70例进行机械通气的ICU患者随机分为鼻胃管组和鼻肠管组,各35例,两组患者均进行肠内营养插管和使用相同的营养剂,比较两组患者的入住ICU时间、机械通气时间、VAP发生率、营养状况、肠道耐受性等。结果鼻肠管组的入院ICU时间、机械通气时间、VAP发生率均明显低于鼻胃管组(P<0.05);接受肠内营养后,两组患者的前白蛋白、载铁蛋白水平均有明显的提高;而且鼻肠管组的前白蛋白水平、载铁蛋白水平高于鼻胃管组(P<0.05);鼻肠管组的腹胀腹泻、反流、误吸、高血糖等发生率均明显低于鼻胃管组(P<0.05)。结论鼻肠管肠内营养可明显改善机械通气患者的营养状况,提高肠道的耐受性,降低VAP的发生率。

Objective To compare the effect of preventing ventilator associated pneumonia （VAP） by nasointes- tinal tube and nasogastric tube nutrition. Methods 70 cases with mechanical ventilation in ICU were randomly di- vided into the nasointestinal tube group and the nasogastric tube group,35 cases in each group. Both groups were car- ried out enteral nutrition intubation and used of the same nutritional agent. Then, the duration of ICU stay and me- chanical ventilation, the incidence of VAP, nutritional state and survivability of intestinal tract were compared be- tween the two groups. Results The duration of ICU stay and mechanical ventilation and the incidence of VAP in the nasointestinal tube group were much lower than those in the nasogastric tube group （P 〈 0.05 ）. After reception of enteral nutrition, the levels of prealbumin and siderophilin of the two groups increased obviously, but the levels were much higher in the nasointestinal tube group than in the nasogastric tube group （ P 〈 0. 05 ）. The incidence of abdom- inal distension and diarrhea, regurgitation, aspiration and hyperglycemia was much lower in the nasointestinal tube group than in the nasogastric tube group （P 〈 0. 05）. Conclusion Nasointestinal tube enteral nutrition could obvi- ously improve nutrition state of mechanical ventilation patients, raise survivability of intestinal tract, and cut down the incidence of VAP.