不同营养方案在老年重症机械通气合并高营养风险患者的应用研究

Study on the application of different nutrition regimens in elderly patients with severe mechanical ventilation combined with high nutritional risk

目的 探讨不同营养方案在老年重症机械通气合并高营养风险患者的应用效果.方法 选取2017年3月~2019年4月在我院ICU进行机械通气治疗合并高营养风险的老年重症患者60例,采用随机数字表法分为对照组和观察组.两组患者均入住ICU 48h内进行幽门后喂养.对照组给予常规的肠内营养护理监测.观察组在常规护理基础上,根据患者目标热卡及蛋白质需要给予补充性肠外营养.观察两组患者入科第7天NUTRIC评分,营养状况:白蛋白、前白蛋白、血红蛋白相关指标情况,治疗期间腹内压情况.结果 ?两组患者入ICU第1天NUTRIC评分、营养状况比较差异无统计学意义(P>0.05).观察组入科第7天NUTRIC评分低于对照组,差异有统计学意义(P<0.05).营养状况:观察组入科第7天白蛋白、前白蛋白、血红蛋白相关指标均明显高于对照组,差异有统计学意义(P<0.05),通过尿管膀胱压测定方法评估腹内压,两组患者腹内压增高情况比较差异无统计学意义(P>0.05).结论 早期补充性肠外营养能有效改善老年患者机械通气合并高营养风险患者的营养不良状态.

Objective To investigate the application effect of different nutrition regimens in elderly patients with severe mechanical ventilation combined with high nutritional risk.Methods 60 elderly patients with severe diseases who received mechanical ventilation treatment at the ICU of our hospital combined with high nutritional risk from March 2017 to April 2019 were divided into the control group and the observation group by random number table method.Both groups of patients were admitted to the ICU and performed with postpyloric feeding within 48 hours.The control group was given routine enteral nutrition nursing monitoring.The observation group was given parenteral nutrition supplementation based on the patients’target calories and protein needs on the basis of routine nursing.The NUTRIC score,nutritional status(albumin,prealbumin and hemoglobin related indexes),and intra-abdominal pressure during therapy were observed in the two groups of patients on the 7th day of admission to our department.Results There was no statistically significant difference in NUTRIC score and nutritional status between the two groups of patients on the first day of ICU admission(P>0.05).The NUTRIC score on the 7th day of admission to our department in the observation group was lower than that in the control group,with statistically significant difference(P<0.05).Nutritional status:The albumin,prealbumin and hemoglobin related indexes on the 7th day of admission to our department in the observation group were significantly higher than those in the control group,with statistically significant difference(P<0.05).Intra-abdominal pressure was evaluated by the urinary-bladder pressure determination method,and there was no statistically significant difference in the increase of intra-abdominal pressure between the two groups of patients(P>0.05).Conclusion Early supplementation of parenteral nutrition can effectively improve malnutrition status in elderly patients with mechanical ventilation combined with high nutritional risk.