基于容量喂养策略在ICU机械通气患者中的应用及对免疫功能指标的影响

Application of Volume-based Feeding Strategy in ICU Patients with Mechanical Ventilation and Its Effect on Immune Function Indexes

目的探讨基于容量喂养策略在重症监护室机械通气患者中的应用及对免疫功能指标的影响。方法选取2019年12月1日-2020年11月30日某院重症医学科收治的无创机械通气患者121例为研究对象,随机分为试验组(61例)和对照组(60例),对照组给予传统的基于速率的喂养策略,试验组给予基于容量的喂养策略,2组喂养策略均进行详细护理记录,比较2组患者能量摄入情况和营养指标变化情况,对2组患者干预前后免疫功能指标进行比较,并观察2组患者喂养并发症发生率。结果试验组患者实际摄入总量(1715.59±246.26)ml和实际摄入量/目标总量(0.93±0.24)明显高于对照组(1472.61±258.23、0.82±0.18)ml,差异有统计学意义(t=5.297、2.849,P=0.000、0.006)。干预后试验组血清白蛋白(43.34±5.31)和前白蛋白(246.34±23.54)明显高于对照组(37.89±4.71、215.38±19.18)(P<0.05)。干预后试验组CD3(69.49±7.61)、CD4+(45.61±5.23)、CD4+/CD8+(1.61±0.24)高于对照组(61.34±6.31、38.34±4.54、1.38±0.18),CD8+(21.18±2.18)低于对照组(26.89±2.71)(P<0.05)。试验组和对照组患者呕吐/反流、腹泻和腹胀发生率差异无统计学意义(χ^(2)=0.460、0.327、0.968,P=0.498、0.567、0.325)。结论通过基于容量的喂养策略可明显提高ICU机械通气患者免疫功能,改善患者营养状况,且安全性较高,值得ICU进一步推广应用。

Objectives To investigate the application of volume-based feeding strategy in patients with mechanical ventilation in intensive care unit and its effect on immune function indexes. Methods A total of 121 patients with non-invasive mechanical ventilation admitted to intensive care department of a hospital from December 1 st, 2019 to November 30 th, 2020 were selected as the study subjects, and were randomly divided into experimental group(61 cases) and control group(60 cases). The control group was given traditional rate-based feeding strategy, and the experimental group was given volume-based feeding strategy. Detailed nursing records were made for the feeding strategies of the two groups. Energy intake and nutritional indicators of the two groups were compared, immune function indicators of the two groups were compared before and after intervention, and the incidence of feeding complications of the two groups were observed. Results The actual total intake of experimental group(1715.59±246.26) mL and the actual intake/target total intake(0.93±0.24) were significantly higher than those of control group(1472.61±258.23, 0.82±0.18) mL, the differences were statistically significant(t=5.297,2.849, P=0.000, 0.006). After intervention, serum albumin(43.34±5.31) and prealbumin(246.34±23.54)in experimental group were significantly higher than those in control group(37.89±4.71, 215.38±19.18)(P<0.05).After intervention, CD3(69.49±7.61), CD4+(45.61±5.23), CD4+/CD8+(1.61±0.24) in experimental groups were higher than those in control group(61.34±6.31, 38.34±4.54, 1.38±0.18). CD8+(21.18±2.18) was lower than that of control group(26.89±2.71)(P<0.05). There were no significant differences in the incidence of vomiting/regurgitation, diarrhea and abdominal distension between the experimental group and the control group(χ^(2)=0.460, 0.327, 0.968, P=0.498, 0.567, 0.325). Conclusions Volume-based feeding strategy could significantly improve the immune function and nutritional status of patients with mechanical ventilation in ICU. It was safe and worthy of further application in ICU.