重症患者阶梯式早期下床活动与肠内营养耐受性相关性研究

Study on the correlation of stage early upright mobilization in critical patients and enteral nutrition-related tolerance

目的探讨重症患者阶梯式早期下床活动与肠内营养耐受性的相关情。方法收集2016年10月至2017年7月入住中南大学湘雅医院重症医学科并实施早期肠内营养的重症患者50例为研究对象。按照随机数字表法分为对照组和观察组各25例，对照组实施常规功能锻炼，观察组实施阶梯式早期下床活动，比较2组患者肠内营养耐受性相关指标、达到目标喂养量的时间、导管相关不良事件发生率。结果2组患者在肠内营养期间胃内容物反流、误吸及腹泻的发生率及导管相关不良事件发生率比较差异无统计学意义（P〉0．05），观察组因胃残余量增加中断肠内营养的发生率为0，低于对照组的20．83％（5／24），差异有统计学意义（r=4．922，P=0．035）。观察组达到目标喂养量的时间为（3．04±0．66）d，少于对照组的（3．57±0．83）d，差异有统计学意义（t=2．409，P=0．025）。结论重症患者阶梯式早期下床活动是安全可行的，可提高肠内营养的耐受性，使患者更快地达到目标喂养量，促进患者疾病的早日康复。

Objective To explore the correlation of stage early upright mobilization in critical patients and enteral nutrition-related tolerance. Methods A total of 50 critically patients with continuous enteral nutrition who admitted in ICU from October 2016 to July 2017 were randomized into two groups; the control group （receiving routine functional exercise in bed） and the observation group （stage early upright mobilization） 25 cases in each group, the correlation of nutrition-related tolerance, the length of target feeding time and incidence of catheter related adverse events were compared. Results There was no statistically significant difference in the incidence of reflux of stomach, aspiration, diarrhea and catheter related adverse events in this two group patients during enteral nutrition （P 〉 0.05）, while the times of interrupting enteral nutrition in the observation group （0） was lower than that of the control group （20.83%, 5/24）, with a statistically significant difference （x2=4.922, P=0.035）. The length of target feeding time was shortened, （3.04±0.66） d in the control group, （3.57±0.83） d in the observation group,with a statistically significant difference （t=2.409, P=0.025）. Conclusions Stage early upright mobilization in critical patients is safe and feasible, it can improve the feeding tolerance and shorten the length of target feeding time to promote the early recovery of the patient＇s disease.