危重症患者应用早期幽门后喂养对肠内营养不耐受症状的影响及临床效果

EFFECT AND CLINICAL EFFECT OF EARLY POSTPYLORIC FEEDING ON INTESTINAL NUTRUTUINAL INTOLERANCE IN CRITICALLY ILL PATIENTS

目的观察危重症患者应用早期幽门后喂养对肠内营养不耐受症状的影响及临床效果。方法回顾分析2020年4月—2021年5月唐山市人民医院收治的79例危重症患者的临床资料,根据喂养方式的不同将其分为观察组与对照组。其中观察组39例,采用幽门后喂养方式。对照组40例,采用幽门前喂养方式。观察二组患者治疗7 d后的蛋白水平和营养状态(通过营养评定量表PG-SGA进行评估),治疗后的病情程度(通过急性生理学及慢性健康状况评分系统APACHE II进行评估),治疗后肠内营养不耐受症状及临床预后的情况。结果经过两种不同方法的干预治疗后,二组患者的状况均有一定好转,观察组治疗7 d后的蛋白水平和营养状态要优于对照组(P<0.05),在7d以内的治疗中,观察组出现恶心或呕吐、胃潴留以及腹胀的情况更少(P<0.05);消化道出血与腹泻发生的情况,二组之间的差距较小(P>0.05);在30d以内的治疗中,与对照组比较,观察组出现获得性肺炎的情况更少(P<0.05);脓毒性休克、器官衰竭、泌尿系统感染等发生的情况,二组之间的差距较小(P>0.05);治疗后观察组住院时间与ICU监护治疗时间要少于对照组(P<0.05)。结论危重症患者应用早期幽门后喂养,可以较为有效地提高患者的营养耐受性,在治疗的过程中有较高的安全性,可以起到良好的效果,这对于患者后续的生活和治疗有着重大的作用与意义。

Objective To observe the clinical effect of early Pyloric feeding on intestinal nutritional intolerance in critically ill patients.Methods The clinical data of seventy-nine critically ill patients admitted to the Tangshan People′s Hospital from April 2020 to May 2021 were reviewed and analyzed, and divided into observation and control groups according to the different feeding methods.Among them, thirty-nine patients in the observation group adopted the post-pyloric feeding method.The control group had forty patients treated before pyloric feeding.Protein levels and nutritional status were observed after seven days(assessed by nutrition assessment scale PG-SGA),the degree of treatment(assessed by acute physiology and chronic health scoring system APACHE II),and symptoms of intestinal nutritional intolerance and clinical outcomes after treatment.Results After two intervention with two different methods, The condition of the patients has been somewhat improved in both groups, Patients in the observation group had better protein levels and nutritional status after seven days of treatment than those in the control group(P<0.05),In the treatment within seven days, Patients in the observation group developed less nausea or vomiting, stomach retention and blodistension(P<0.05);Conditions of gastrointestinal bleeding and diarrhea, The gap between the two groups was small(P>0.05);In the treatment of within thirty days, In contrast to the control group, Patients in the observation group developed less acquired pneumonia(P<0.05);Septic shock, organ failure, urinary system infection, etc, The gap between the two groups was small(P>0.05);Less hospitalization and ICU care time were observed in the observation group after treatment than in the control group(P<0.05).Conclusion critically ill patients with early pyloric feeding can improve their nutritional tolerance with high safety and good effect, which has great significance for the subsequent life and treatment of patients.