早期营养支持降低ICU肿瘤重症患者呼吸机相关性肺炎的临床效果

Early Nutritional Support Reducing the Clinical Effect of Ventilator-associated Pneumonia in Patients with Severe ICU Tumors

目的对ICU肿瘤重症患者通过早期营养支持的方法进行治疗,对患者的呼吸机相关性肺炎的发生率降低情况进行研究。方法对该院在2017年1月—2018年1月,这一期间内收治的患者随机抽取出68例患者,把他们当成该次研究的研究目标,根据患者的例数将小组进行划分,分为观察组(n=34)和对照组(n=34)。对照组患者通过常规的营养支持方法进行治疗;观察组患者通过实施早期肠内+肠外的营养支持方法进行治疗。对观察组以及对照组患者发生呼吸机肺炎(VAP)的概率、机械通气时间、住院时间以及患者的死亡率展开对比分析;再将两组患者的治疗之后的血红蛋白水平、淋巴细胞计数、血清总蛋白含量以及血清白蛋白含量情况展开比较分析。结果观察组患者获得的VAP得发生概率、机械通气时间、住院时间以及患者死亡率分别为:14.71%、(8.49±3.25)d、(10.98±1.26)d、 8.82%,而对照组患者获得的VAP得发生概率、机械通气时间、住院时间以及患者死亡率分别为:26.47%、(13.29±2.57)d、(16.49±2.01)d、23.53%,观察组患者获得的VAP得发生概率、机械通气时间、住院时间以及患者死亡率均显著优良于对照组,组间差异有统计学意义(χ~2=5.264 8, t=5.023 5, 4.259 4, 5.467 2, P<0.05)。治疗之后,观察组患者的血红蛋白水平、淋巴细胞计数、血清总蛋白含量以及血清白蛋白含量情况分别为:(107.54±8.48)g/L、(17.2±1.24)×10~9/L、(33.58±2.75)g/L、(59.48±3.67)g/L,对照组患者的血红蛋白水平、淋巴细胞计数、血清总蛋白含量以及血清白蛋白含量情况:(97.24±8.41)g/L、(16.25±1.21)×10~9L、(27.35±2.56)g/L、(47.65±3.49)g/L,观察组患者的血红蛋白水平、淋巴细胞计数、血清总蛋白含量以及血清白蛋白含量情况的改善度更加明显,差异有统计学意义(t=4.521 6,3.526 9,4.219 8,4.751 3,P<0.05)。结论早期营养支持可以有效降低ICU肿瘤重症患者呼吸机相关性肺炎的发生几率,改善患者的营养状况和预后。

Objective To treat patients with severe ICU tumors through early nutritional support and to study the incidence of ventilator-associated pneumonia. Methods From January 2017 to January 2018 in the hospital, 68 patients were randomly selected from this period. They were considered as the research targets of the sub-study, and the group was divided according to the number of patients. They were divided into observation group （n=34） and control group （n=34）. Patients in the control group were treated by conventional nutritional support methods; patients in the observation group were treated by early enteral ＋ parenteral nutrition support. Comparative analysis of the probability of ventilator pneumonia （VAP）, mechanical ventilation time, hospital stay, and patient mortality in the observation group and the control group; hemoglobin level, lymphocyte count, and serum total after treatment in both groups. The protein content and serum albumin content were compared and analyzed. Results The incidence of VAP, mechanical ventilation time, hospital stay, and patient mortality in the observation group were 14.71%, （8.49±3.25）d, （10.98±1.26）d, 8.82%, respectively. The probability of occurrence of VAP, mechanical ventilation time, length of hospital stay, and patient mortality were： 26.47%,（13.29 ± 2.57）d, （16.49±2.01）d , 23.53% , the probability of VAP obtained in the observation group , mechanical Ventilation time, hospital stay, and patient mortality were significantly better in the control group, and the differences between the groups were statistically significant （χ2=5.264 8, t=5.023 5, 4.259 4, 5.467 2,P〈0.05）, respectively. After treatment, the hemoglobin level, lymphocyte count, serum total protein content and serum albumin content of the observation group were （107.54 ± 8.48）g/L,（17.2±1.24）×109/L, （33.58 ±2.75）g/L, （59.48±3.67）g/L, hemoglobin level, lymphocyte count, serum total protein content and serum albumin content of the control group： （97.24±8.41）g/L,（16.25±1.21）×109/L,（27.35±2.56）g/L,（47.65±3.49）g/L, the improvement of hemoglobin level, lymphocyte count, serum total protein content and serum albumin content in the observation group was more obvious, the difference was statistically significant （t=4.521 6, 3.526 9, 4.219 8, 4.751 3,P〈0.05）. Conclusion Early nutritional support can effectively reduce the incidence of ventilator-associated pneumonia in patients with severe ICU tumors and improve their nutritional status and prognosis.