高蛋白肠内营养对危重患者机械通气时间及营养状况的影响

Effect of high protein enteral nutrition on mechanical ventilation time and nutritional status of critically ill patients

目的观察高蛋白肠内营养(EN)对行机械通气危重患者临床疗效的影响.方法采用前瞻性研究方法,选择舟山医院重症监护病房(ICU)2015年1月至2017年12月收治的接受有创机械通气的危重症患者64例作为研究对象.以给予2.0 g·kg^(-1)·d-1蛋白质的34例患者作为高蛋白EN组,给予1.2 g·kg^(-1)·d^(-1)蛋白质的30例患者作为对照组.观察两组治疗后营养指标〔白蛋白(Alb)、前白蛋白(PA)、转铁蛋白(TRF)〕和膈肌功能、机械通气时间、入住ICU时间、住院时间、呼吸机相关性肺炎(VAP)发生率、28 d病死率、住院总费用的差异.结果两组治疗前后及两组间Alb水平比较差异均无统计学意义(均P>0.05);随时间延长,两组治疗后PA和TRF均逐渐升高,治疗5 d时两组开始出现统计学差异〔PA(g/L):0.180±0.078比0.128±0.043,TRF(g/L):1.423±0.394比1.089±0.185,均P<0.05〕,治疗14 d时达到最高水平,且高蛋白EN组明显高于对照组〔PA(g/L):0.252±0.071比0.160±0.047,TRF(g/L):1.796±0.611比1.376±0.353,均P<0.05〕.与对照组比较,高蛋白EN组膈肌功能改善明显〔膈肌活动度(mm):15.6±2.0比11.2±2.1,膈肌增厚分数:(35.6±3.4)%比(28.6±3.2)%,均P<0.05〕,机械通气时间(d:5.82±1.75比7.83±2.69)和入住ICU时间(d:8.97±2.32比11.60±3.68)均明显缩短(均P<0.05),VAP发生率明显降低〔20.6%(7/34)比63.3%(19/30),P<0.05〕,住院总费用明显减少(万元:5.52±1.80比6.80±2.26,P<0.05).高蛋白EN组和对照组住院时间(d:19.94±5.25比20.33±5.47)和28 d病死率〔20.6%(7/34)比23.3%(7/30)〕有降低趋势,但差异均无统计学意义(均P>0.05).结论高蛋白EN用于机械通气的危重症患者,能更好地恢复其呼吸功能,缩短机械通气时间和入住ICU时间,降低VAP发生率,减少住院费用.

Objective To observe the effect of high-protein enteral nutrition(EN)on clinical efficacy in critically ill patients with mechanical ventilation.Methods The prospective study method was used,64 critically ill patients treated with invasive mechanical ventilation in intensive care unit(ICU)of Zhoushan Hospital during January 2015 to December 2017 were selected as research objects.The high-protein EN group(34 cases)was given 2.0 g·kg^(-1)·d^(-1) protein,and the control group(30 cases)was given 1.2 g·kg^(-1)·d^(-1)protein.After treatment,the nutritional indexes[albumin(Alb),prealbumin(PA),transferrin(TRF)]and diaphragmatic function,mechanical ventilation time,ICU stay,hospitalization time,incidence of ventilator-associated pneumonia(V AP),28-day mortality and total hospitalization expenses were observed in both groups.Results There were no significant differences in Alb levels between the two groups before and after treatment(all P>0.05);gradually with the prolongation of time,after treatment,PA and TRF began to be increased showing significant differences between the two groups on day 5[PA(g/L):0.180±0.078 vs.0.128±0.043,TRF(g/L):1.423±0.394 vs.1.089±0.185,both P<0.05],reaching the highest level on day 14,and the levels of PA and TRF in high-protein EN group were significantly higher than those in control group[PA(g/L):0.252±0.071 vs.0.160±0.047,TRF(g/L):1.796±0.611 vs.1.376±0.353,both P<0.05].Compared with the control group,diaphragmatie muscle function in high-protein EN group was significantly improved[diaphragm activity(mm):15.6±2.0vs.11.2±2.1,diaphragmatic muscle thickness fraction:(35.6±3.4)%vs.(28.6±3.2)%,both P<0.05],mechanical ventilation time(days:5.82±1.75 vs.7.83±2.69),and ICU stay(days:8.97±2.32 vs.11.60±3.68)were significantly reduced(all P<0.05),the incidence of VAP was significantly decreased[20.6%(7/34)vs.63.3%(19/30)..P<0.05],total cost of hospitalization was significantly reduced(ten thousand Yuan:5.52±1.80 vs.6.80±2.26,P<0.05).The length of hospitalization(days:19.94±5.25 vs.20.33±5.47)and 28-day mortality[20.6%(7/34)vs.23.3%(7/30)]in high-protein EN group had a tendency of lowering than those in the control group,but no significant differences between the two groups were seen(bothP>0.05).Conclusion For critically ill patients with treatment of mechanical ventilation,high-protein EN can better restore their respiratory function,effectively shorten the durations of mechanical ventilation and ICU stay,reduce the incidence of VAP,and decrease the cost of hospitalization.