多学科协作团队干预早期肠内营养对危重症患者肺部感染的效果

Effect of early enteral nutrition intervention implemented by multidisciplinary collaborative team on lung infections in critically ill patients

目的探究多学科协作团队(MDT)干预早期肠内营养对危重症患者肺部感染率的效果.方法选择2021年1月-2022年8月兰州大学第二医院急诊科收治的98例ICU重症患者为研究对象,随机分为研究组与对照组,各49例,对照组给予常规的肠外营养支持,研究组予以MDT营养管理模式.对比干预前、干预10天后,两组患者营养指标、免疫功能指标及住院期间肺部感染率、早期康复指标及胃肠道并发症情况.结果对照组肺部感染感染率为18.37%(9/49)高于研究组(P=0.008);10天营养支持后,研究组前清蛋白(PA)较干预前升高(P<0.05),且总蛋白(TP)、血红蛋白(Hb)、PA及清蛋白(ALB)水平均高于对照组(P<0.05);研究组免疫球蛋白A(IgA)、IgG、IgM高于干预前及对照组(P<0.05),对照组IgA、IgM高于治疗前(P<0.05);研究组的呼吸机待机时间、首次经口进食时间、拔出胃管时间及拔出尿管时间均短于对照组(P<0.05);两组患者胃肠道并发症发生率差异无统计学意义.结论MDT协作团队实施的早期肠内营养干预可改善免疫功能及营养状态,降低危重症患者肺部感染率,减少并发症发生率.

OBJECTIVE To explore the impact of early enteral nutrition intervention implemented by multidiscipli-nary team(MDT)on lung infections in critically ill patients.METHODS Totally 98 cases of ICU patients admitted to the emergency department of the second hospital of Lanzhou university from Jan.2021 to Aug.2022 were se-lected as the study subjects,and were randomly divided into the study group and the control group,with 49 cases in each group.The control group was given routine parenteral nutrition support,and the study group was given MDT nutrition management mode.The nutritional indexes and immune function indexes of the two groups before intervention and 10 days after intervention,as well as the incidence of pulmonary infection,early recovery indexes and gastrointestinal complications during hospitalization were compared between the two groups.RESULTS The infection rate of lung infection in control group was significantly higher than that in study group(P=0.008).Af-ter 10 days of nutritional support,the prealbumin(PA)in the study group was increased compared with that be-fore intervention(P<0.05),and the levels of total protein(TP),hemoglobin(Hb),PA and albumin(ALB)in the study group were higher than those in the control group(P<0.05).The immunoglobulin A(IgA),IgG and IgM in the study group were higher than those before intervention and in the control group(P<0.05),and IgA and IgM in the control group were higher than those before treatment(P<0.05).The standby time of ventilator,time to first oral feeding,time to remove gastric tube and time to remove urinary tube in the study group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of gastroin-testinal complications between the two groups.CONCLUSION Early enteral nutrition intervention implemented by a collaborative MDT team improved immune function and nutritional status,reduced the incidence of lung infec-tion and decreased the rate of complications in critically ill patients.