早期肠内营养对ICU中实施连续肾脏替代疗法患者的效果分析

The effect of early enteral nutritional support on critical patients with continuous renal replacement therapy

目的探讨早期肠内营养对重症监护病房中实施床旁连续肾脏替代疗法的重症患者的疗效。方法分析2013年1月～2016年1月入住ICU并实施床旁连续肾脏替代疗法90例重症患者,根据是否在连续肾脏替代疗法开始48h内实施肠内营养分为早期肠内营养组46例和肠内营养支持组44例,分别检测治疗开始第1d、第3d、第7d、第14d、第21d、第28d的血清白蛋白、血红蛋白、血清前白蛋白、凝血酶原时间、纤维蛋白原、尿素氮、血肌酐、急性生理和慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation Ⅱ score,APACHE Ⅱ score),比较2组8项指标的差异。结果 2组患者的血清白蛋白、血红蛋白、前白蛋白、凝血酶时间及APACHE Ⅱ评分结果之间存在统计学差异(F组间值分别为6.786,4.308,4.699,4.650,4.186;P值分别为0.012,0.043,0.035,0.036,0.046)。结论早期肠内营养对改善连续肾脏替代治疗的重症患者的蛋白水平、凝血功能及病情严重程度方面有积极作用。

Objective The aim of the study was to evaluate the influence of early enteral nutrition support on critically ill patients treated with continuous renal replacement therapy(CRRT)in intensive care unit.Methods This was a retrospective cohort study of 90 critical patients treated with CRRT in ICU in the period between January 2013 and January 2016.They were divided into two groups;EEN group(n=46)in which patients began to have enteral nutrition support within 48 hours after CRRT,and EN group(n=44)in which patients began to have enteral nutrition support more than 48 hours after CRRT.Serum prealbumin,hemoglobin,albumin,prothrombin time,fibrinogen,blood urea nitrogen,creatinine and Acute Physiology and Chronic Health EvaluationⅡscore(APACHEⅡscore)were assayed at baseline and after the nutritional support for 1,3,7,14 and 28 days.These parameters were compared between the two groups.Results There were statistical significances in the levels of albumin(Fbetween=6.786,P=0.012),hemoglobin(Fbetween=4.308,P=0.043),prealbumin(Fbetween=4.699,P=0.035),prothrombin time(Fbetween=4.650,P=0.036)and APACHEⅡscore(Fbetween=4.186,P=0.046)between the two groups.Conclusion Early enteral nutrition has positive effects on albumin level,blood coagulation function and APACHEⅡscore in critical patients on CRRT.