肠外肠内营养序贯疗法对机械通气重症患者的临床效果

Effect of early enteral nutrition combined with parenteral nutrition sequential treatment for critical patients with mechanical ventilation

目的探讨肠外肠内营养序贯治疗机械通气重症患者的效果。方法选择2016年1~12月新疆医科大学第二附属医院重症医学二科行机械通气的重症患者100例,按随机数字表法分为治疗组和对照组,每组各50例。对照组给予全肠外营养支持,治疗组给予肠外肠内营养序贯治疗方案,除此之外两组的治疗方案相同。入院时及住院14 d时监测患者的血清白蛋白(Alb)、血清前白蛋白(PA)、血清转铁蛋白(TRF)、免疫球蛋白(Ig G)及三头肌皮褶厚度(TSF)等营养指标。观察患者呼吸机相关性肺炎(VAP)的发生情况。比较两组患者机械通气时间及入住ICU时间。结果干预后,两组患者Alb、PA、TRF、Ig G及TSF等营养指标均优于入院时,且治疗组各项营养指标均优于对照组,差异有统计学意义(P<0.05)。治疗组患者机械通气时间、入住ICU时间较对照组明显缩短,治疗组VAP的发生率明显低于对照组,差异有统计学意义(P<0.05)。结论对于重症机械通气患者早期实施肠外肠内营养序贯治疗,能改善患者营养状况,调节其免疫功能,减少呼吸机相关性肺炎的发生,缩短机械通气时间,减少住院时间,值得临床推广应用。

Objective To determine the effect of implementing early enteral nutrition combined with parenteral nutrition sequential treatment and outcomes of critical patients with mechanical ventilation. Methods From January to December 2016, in Second Department of Intensive Care Medicine of Second Affiliated Hospital of Xinjiag Medical University, according to random number table, 100 critical patients with mechanical ventilation support were divided into treatment group and control group, with 50 cases in each group. The control group was given total parenteral nutrition support, and the treatment group was treated with early enteral nutrition combined with parenteral nutrition sequential treatment, other treatment of two groups were same. Alb, PA, TRF, IgG, TST of patients were evaluated at admission and 14 d in hospital, ventilator associated pneumonia （VAP） of patients were observed, mechanical ventilation time, ICU stay time of patients in two groups were compared. Results After intervention, Alb, PA, TRF, IgG, TST of two groups were better than admission, and these of treatment group were better than control group, the differences were statistically significant （P 〈 0.05）. The mechanical ventilation time, ICU stay time of treatment group were less than control group, rate of VAP in treatment group were less than control group, the differences were statistically significant （P 〈 0.05）. Conclusion Early enteral nutrition combined with parenteral nutrition sequential treatment for critical patients with mechanical ventilation can improve nutritional status, regulate the immune function, reduce the prevalence of ventilator-associated pneumonia, shorten the mechanical ventilation time and hospitalization stay.