早期添加果胶的肠内滋养型营养对ICU重症患者的影响

Effect of early adding pectin enteral nourishing nutrition on critically ill patients in ICU

目的探讨添加果胶(PEC)的早期肠内营养(EEN)对重症监护病房(ICU)重症患者预后和并发症的影响。方法选取ICU重症患者,随机数字表法分为对照组(EEN组)和研究组(PEC/EEN组)。对照组在试验前6 d采用肠内营养(EN)制剂早期肠内营养支持,研究组在对照组的基础上添加了果胶制剂。喂养6 d后,两组均按完全相同的喂养方案继续至目标剂量。主要研究终点是患者30 d病死率、胃肠不耐受的频率、非感染性并发症发生率和达到全量EN的时间;次要研究终点包括ICU住院时间、总住院时间和血糖的变化。结果研究组患者30 d病死率、器官支持的时间和对照组相比均未见明显差异(P=0.32);研究组非感染性并发症显著低于对照组(P=0.01);达到全量EN的时间显著低于对照组(P=0.05);ICU住院时间(P=0.04)和总住院时间(P<0.01)在研究组均明显降低;整个过程中,研究组平均血糖值波动较小。结论与传统ICU重症患者EEN的给予相比,早期添加果胶虽不能改善30 d病死率,但能降低胃肠不耐受性,减少感染性并发症发生率,从而改善患者胃肠功能的恢复,缩短达到全量EN的所需时间。

Objective To investigate the effect of adding pectin(PEC)in early trophic enteral nutrition(EEN)on the prognosis and complications in ICU critically ill patients.Methods The critically ill patients in ICU were selected and divided into the control group(EEN,n=63)and study group(PEC/EEN group,n=62)by adopting the random number table method.The control group adopted the enteral nutrition(EN)preparations for early enteral nutrition support on 6 d before experiment,while the study group was added with PEC preparation on the basis of the control group.After 6 d feeding,the two groups continued to the targeted dose according to the completely same feeding scheme.The main study end spoints were the fatality rate on 30 d,frequency of gastrointestinal intolerance,occurrence rate of non-infection complications and time reaching full dose EN;the secondary study end points included the ICU stay duration,total hospitalization duration and blood glucose change.Results The fatality rate on 30 d and organ support time had no obvious difference between the study group and control group(P=0.32);the non-infection complications in the study group were significantly lower than those in the control group(P=0.01);the time reaching the full dose EN in the study group was significantly lower than that in the control group(P=0.05);the ICU stay time(P=0.04)and total hospitalization duration(P<0.01)in the study group were significantly decreased;during the whole process,the fluctuation of blood glucose value in the study group was smaller.Conclusion Compared with EEN giving in the traditionally ICU critically ill patients,although early adding PEC can not improve the fatality rate on 30 d,but can decrease the gastrointestinal intolerance,reduce the occurrence rate of infectious complications,thus improve the gastrointestinal function recovery,shorten the time reaching the full dose EN.