两种肠内营养液应用于老年重症肺炎患者的临床疗效观察

Clinical effects of two different enteral nutritional emulsions in elderly patients with severe pneumonia

目的︰比较匀速管饲瑞高肠内营养乳剂(TP-HE)与匀速管饲标准配方瑞先肠内营养液(TPF)在老年重症肺炎患者营养支持治疗的疗效。方法随机同期对照试验,收集符合重症肺炎诊断标准、应激性高血糖需用胰岛素的老年患者(≥65岁)56例,数字抽签分为经鼻胃管匀速滴注TP-HE组和TPF组各28例。两组患者均根据理想体重计算每天能量供应总量,连续记录1d,2d,3d、4d、5d,6d,7d前白蛋白、血清白蛋白,体质指数及血红蛋白,一般线性模型重复测量方差分析老年重症肺炎患者营养支持治疗的疗效。结果入院时TP-HE组和TPF组患者前白蛋白[(244.5±55.1)mg/L比(237.8±40.4)mg/L]、血清白蛋白[(37.6±5.6)mg/L比(38.3±5.5)mg/L],体质指数[(21.9±0.2)kg/m^(2)比(22.4±0.2)kg/m^(2)]、血红蛋白[(104.4±26.8)mg/L比(103.6±25.6)mg/L]比较,差异无统计学意义(均P>0.05)。TP-HE组和TPF组患者能量(79.8±4.8)kcal/d比(79.3±6.6)kcal/d,差异无统计学意义(均P>0.05)。TP-HE组与TPF组患者1d、2d,3d,4d,5d,6d、7d前白蛋白比和血清白蛋白两两比较,差异均有统计学意义(P<0.01和P<0.05),TP-HE组与TPF组患者不同时间前白蛋白、血清白蛋白提升情况不同;血红蛋白的重复测量除第一天和第二天差异无统计学意义(P>0.05)外,其他各时间两两比较差异有统计学意义(均P<0.01);TP-HE组与TPF组患者体质指数比较,差异无统计学意义(F=1.709,P>0.05)。结论︰两种不同肠内营养液对前白蛋白、血清白蛋白、血红蛋白有提升作用,其中TP-HE对前白蛋白、血清白蛋白及血红蛋白影响更显著,且给予TP-HE和TPF患者体质指数各时间点均无差异。

Objective To compare the clinical effects of two enteral nutritional emulsions,TP-HE and TPF,in elderly patients with severe pneumonia.Methods This was a randomized studywith contemporaneous controls.A total of 56 elderly patients over 65 years old who met the diagnosticcriteria for severe pneumonia and were receiving insulin were enrolled.They were randomly dividedinto the observation group(n=28,enteral TPF-HE at a uniform rate through a nasogastric tube)andthe control group(n=28 cases,enteral TPF at a uniform rate through a nasogastric tube).The totaldaily energy supply was calculates based on the ideal weights of patients.Prealbumin(PA),serumalbumin(ALB),body mass index(BMI)and hemoglobin(Hb)were continuously measured at 1,2,3,4,5,6 and 7 days after treatment.The effects of the enteral nutritional emulsions in elderly patients withsevere pneumonia were analyzed by using repeated measures analysis of variance in a general linearmodel.Results There was no significant difference in PA(244.5±55.1)mg/L vs.(237.8±40.4)mg/L,ALB(37.6±5.6)mg/L vs.(38.3±5.5)mg/L,BMI(21.9±0.2)kg/m^(2)vs.(22.4±0.2)kg/m^(2))or Hb(104.4±26.8)mg/L vs.(103.6±25.6)mg/L between the TP-HE group and the TPF groupbefore admission(P>0.05).The energy received from the enteral nutritional emulsions was notsignificantly different between the TP-HE group and the TPF group(79.8±4.8)kcal/d vs.(79.3±6.6)kcal/d(P>0.05).PA and serum ALB levels had significant differences between the TP-HEgroup and the TPF group at 1,2,3,4,5,6 and 7 days after treatment(P<0.01 or 0.05).Increases inPA and serum ALB levels varied at certain time points between the TP-HE group and the TPFgroup.Hb levels had no significant difference at 1 and 2 days(P>0.05),but were significantly different at other time points between the two groups(P<0.01).There was no significant differencein BMI between the two groups(F=1.709,P>0.05).Conclusions Both of the enteral nutritionemulsions can improve PA,ALB and Hb levels,with TP-HE offering more significant effects on PA,ALB and Hb levels.There is no difference in BMI at any time point whether patients receive TP-H Eor TPF.