肠内营养不耐受标准化流程管理对重症肺炎机械通气患者血糖控制及预后的影响

Effect of enteral nutrition intolerance process management on blood glucose control and prognosis in patients of severe pneumonia with mechanical ventilation

目的探讨在重症肺炎有创机械通气患者中采取早期肠内营养(EN)不耐受标准化流程管理对患者血糖控制作用及相关预后的影响。方法 54例重症肺炎有创机械通气患者分为两组,两组患者均给予常规治疗并于入院24～48 h内开始早期经鼻肠管肠内营养治疗。在肠内营养治疗期间,实验组实行肠内营养不耐受标准化流程管理,对照组实行常规管理。比较两组营养支持指标、血糖变异性指标、氧合指数、肺泡动脉血氧分压差、预后相关指标。结果经过肠内营养不耐受标准化流程管理,患者首次排便时间、达目标喂养量时间明显提前,实验组患者7 d EN/EN+PN比值、7 d鼻肠管达标比例明显高于对照组患者(t分别=27.81、20.64,χ~2分别=36.22、38.33,P均<0.05)。实验组患者整体血糖变异程度(血糖变异系数、最高血糖值、最低血糖值)均明显优于对照组(t分别=21.86、18.62、10.73,P均<0.05),实验组患者高血糖发生率明显低于对照组(χ~2=41.86,P<0.05)。自病程第9天起,实验组患者氧合指数明显优于对照组(t分别=16.69、18.32,P均<0.05),自病程第7天起,实验组肺泡-动脉血氧分压差明显低于对照组(t分别=14.87、16.26、8.34、6.26,P均<0.05);实验组患者多器官功能障碍综合征(MODS)发生率、有创机械通气时长明显低于对照组(χ~2=26.62,t=6.86,P均<0.05);但两组患者28 d病死率、入住ICU时间比较,差异无统计学意义(χ~2分别=5.62,t=3.34,P均>0.05)。结论对重症肺炎有创机械通气患者进行EN不耐受标准化流程管理可改善营养状况,降低血糖波动水平,改善预后。

Objective To explore the effect of the early enteral nutrition(EN)intolerance standardized process management on blood glucose control and prognosis in patients of severe pneumonia with mechanical ventilation.Methods Totally 54 patients of severe pneumonia with mechanical ventilation were selected and divided into the experimental group(28 cases)and the control group(26 cases).Patients were all received routine treatment and early enteral nutrition through nasointestinal tube within 24 to 48 hours after admission.Patients in the experimental group were given standardized management of enteral nutrition intolerance,while the control group were given routine management.The nutritional support parameters,the blood glucose variability parameters,the respiratory function related parameters,and the prognostic indicators were compared between the two groups.Results After the early enteral nutrition(EN)intolerance standardized process management,the first defecation time,the time of completing target feeding,the 7-day EN/PN ratio,and the 7-day nasal bowel arrival rate were significantly improved(t=27.81,20.64,χ^2=36.22,38.33,P<0.05).The blood glucose coefficient of variation,the highest and the minimum levels of blood glucose of the experimental group were significantly better than those of the control group(t=21.86,18.62,10.73,P<0.05).The incidence of hyperglycemia was significantly lower than that of the control group(χ^2=41.86,P<0.05).From the 9th day of the disease course,the oxygenation index of the experimental group was significantly better than that of the control group(t=16.69,18.32,P<0.05),and from the 7th day of the disease course,the alveolar-arterial oxygen pressure difference of the experimental group was significantly lower than that of the control group(t=14.87,16.26,8.34,6.26,P<0.05).The incidence of MODS and the time of invasive mechanical ventilation of the experimental group were significantly lower than those of the control group(χ^2=26.62,t=6.86,P<0.05).However,there was no significant difference in the 28-day hospital mortality and the ICU stay time between the two groups(χ^2=5.62,t=3.34,P >0.05).Conclusions The EN intolerance standardized process management may improve the nutritional status of the patients of severe pneumonia with mechanical ventilation,lower blood sugar fluctuations,and improve the prognosis.