危重症患者胃肠功能对呼吸机相关性肺炎发生情况的影响分析

Analysis of the effect of gastrointestinal function on the incidence of ventilator associated pneumonia in critically ill patients

目的探讨危重症患者胃肠功能对呼吸机相关性肺炎(VAP)发生情况的影响。方法 2012年8月到2016年6月选择在我院重症监护室(ICU)行机械通气的危重症患者160例作为研究对象,根据随机信封抽签原则分为观察组与对照组各80例,对照组采用鼻胃管经胃喂养途径,观察组采用胃肠双腔管经肠道喂养途径。两组肠内营养支持观察时间为7 d,记录与两组VAP发生与预后情况。结果对照组与观察组肠内营养期间的胃液p H值分别为6.13±1.38和4.01±1.83,观察组明显低于对照组(t=4.982,P<0.05)。观察组与对照组肠内营养期间的VAP发生率分别为2.5%和12.5%,观察组的的VAP发生率明显低于对照组(P<0.05)。观察组与对照组营养支持后的血清前白蛋白和白蛋白值都明显高于营养支持前(P<0.05),营养支持后观察组的血清前白蛋白和白蛋白值与对照组相比也明显增高(P<0.05)。观察组的机械通气时间与ICU住院时间分别为9.12±2.13d和12.76±1.98d,与对照组的10.56±2.89d和16.33±2.11d相比明显减少(P<0.05)。结论 ICU危重症患者胃肠功能存在一定的障碍,胃肠双腔管经肠道喂养能改善患者的营养状态,促进维持正常胃液p H值,从而减少VAP的发生,有利于患者的康复。

Objective To investigate the effect of gastrointestinal function on the incidence of ventilator associated pneumonia （VAP） in critically ill patients. Methods From August 2012 to June 2016, 160 critically illpatients in the ICUof our hospital were selected as the research object,and all the the observation group and the control group. The control group was given nasogastric tube observation group was given the dual lumen gastrointestinal enteral for gastric feeding. The enteral tion times were 7d,and the occurrence and prognosis were recorded. Results The pH value of control group and the observation group were 6. 13 ± 1. 38 and 4. 01 ± 1. 83 respectively,and the observation group was significantly lower than that of the control group （ t= 4. 9 8 2 ,P 〈 0. 05 ） . The incidence of VAP in the observation group and the control group were 2. 5% and 12. 5% , respectively,and the observation group was significantly lowerthan that of the control group （ P 〈 0. 05 ）. The serum levels of pre-all Dumin and allDumin ;ter feeding tion group and the control group were significantly higher tlian those of before feeding （ P 〈 0. 05 ）,and the serum levels of pre-allDumin and allDumin in the observation group after feeding were significantly higher than those in the control group （ P 〈 0. 05 ）. The mechanical ventilation time and ICUlength of stay in the observat2. 13d and 12. 76 ± 1. 98d,respectively,which were significantly lower than that of the control group of 10. 56 ± 2. 89d and 16. 33 ± 2. 11d （ P 〈 0. 05 ） . Conclusion Gastrointestinal function obstacles are common in ICU critically ill patients,and dual lumen gastrointestinal enteral for gastric feeding can improve their nutritional status,promote and maintain the normal pH value of gastric juice, so as to reduce the incidencpatients.