基于前馈控制理论的肠内营养支持联合腹内压监测对机械通气患者喂养耐受的影响

Effect of enteral nutrition support based on feedforward control theory combined with intra-abdominal pressure monitoring on feeding tolerance in patients with mechanical ventilation

目的评价基于前馈控制理论的肠内营养支持联合腹内压监测对机械通气患者喂养耐受的影响。方法选择接受机械通气的116例患者进行前瞻性研究,对照组(58例)接受常规肠内营养策略,观察组(58例)实施基于前馈控制理论的肠内营养支持联合腹内压监测,对比两组机械通气时间、住院时间、腹内压变化、营养状态指标[血清白蛋白(ALB)、血清前白蛋白(PA)、血红蛋白(HB)]、喂养耐受情况及并发症。结果观察组机械通气时间、住院时间及干预后14 d腹内压均较对照组低,差异有统计学意义(t分别=3.47、3.20、6.85,P均<0.05);观察组干预后14 d血清ALB、PA、HB水平均比对照组高,差异有统计学意义(t分别=2.56、3.18、4.85,P均<0.05);观察组肠内营养耐受性优于对照组(Z=2.60,P<0.05),且并发症发生率(6.90%)比对照组(20.69%)低,差异有统计学意义(χ~2=4.64,P<0.05)。结论基于前馈控制理论的肠内营养支持联合腹内压监测用于机械通气患者中可缩短住院时间及机械通气时间,降低腹内压,改善营养状态,提高喂养耐受度,减少相关并发症发生。

Objective To evaluate the effect of enteral nutrition support based on feedforward control theory combined with intra-abdominal pressure monitoring on feeding tolerance in mechanically ventilated patients.Methods A prospective study enrolled 116 patients who underwent mechanical ventilation was preformed.The control group(58 patients)received conventional enteral nutrition care strategies.The observation group was received enteral nutrition support based on feedforward control theory combined with intra-abdominal pressure monitoring. The mechanical ventilation time,hospitalization time,intra-abdominal pressure changes,nutritional status parameters including serum albumin(ALB),serum prealbumin(PA),and hemoglobin(HB),feeding tolerance and complications between two groups were compared. Results Compared with the control group,the mechanical ventilation time,hospitalization time and intra-abdominal pressure at 14 days after intervention were significantly lower in the observation group(t=3.47,3.20,6.85,P<0.05).The levels of ALB,PA and HB in the observation group were significantly higher than those in control group at 14 days after intervention(t=2.56,3.18,4.85,P<0.05).The enteral nutrition tolerance of the observation group was better than that of the control group(Z=2.60,P<0.05),and the complication rate(6.90%)was lower than that of the control group(20.69%).The difference was statistically significant(χ~2=4.64,P<0.05). Conclusion Enteral nutrition support based on feedforward control theory combined with intra-abdominal pressure monitoring for mechanical ventilation can shorten hospitalization time and mechanical ventilation time,reduce intra-abdominal pressure,improve nutritional status,improve feeding tolerance,and reduce the incidence of related complications.