外科危重病人早期肠内营养的监护与研究

Monitoring and Studying of Early EN on Critical Surgery Patients

目的 探讨早期肠内营养 (EN)在外科危重病人中的合理应用 ,分析肠内营养胃肠道并发症相关因素及监护方法。方法 对 48例外科危重病人实施EN ,根据病情分单纯消化道手术组 (31例 )与重症组 (17例 )。观察 2组肠道喂养量、输注速度、EN天数、血清蛋白及肠道耐受情况 ,进行对照研究。结果 单纯手术组对术后早期EN耐受较好。重症组EN天数、腹泻、腹胀的发生率高于手术组 ;腹泻发生与ALB水平呈负相关 ,与APACHE -Ⅱ、输注速度呈正相关。结论 加强外科危重病人EN过程监护及正确选择EN途径及输注方式十分重要 ,消化道大手术后尽早过渡到EN是安全可行的。重症组EN胃肠道相关并发症的发生率明显增高 ,多以PN +EN形式实现其营养支持。

Objective To explore the rational application of early EN to surgery critical patients, analyze the monitoring methods and related factors of gastrointestinal complication. Method According to patients' condition,they were divided into digestive tract operation group(31) and serious group(17). Observe intestinal injection quantity, injection pace, days of EN, ALB and intestinal tolerance. Result The complications such as diarrhea, abdominal distension in serious group were higher than operation group. The relativity of diarrhea and ALB was negative correlation and was positive with APACHE-II and injection pace. Conclusion It is important to monitor EN. It is safe and feasible to try EN as early as possible after operation. The gastrointestinal complications were all obviously higher in serious group. EN plus PN can be competent for nutrition at these times.=