早期间断肠内营养在心脏外科术后重症患者中的应用效果

Evaluation on the effect of early intermittent enteral nutrition in critically ill patients after cardiac surgery

目的探讨早期间断肠内营养(enteral nutrition,EN)在心脏外科术后重症患者中的应用效果。方法构建心脏外科术后重症患者早期EN喂养方案,前瞻性分析2022年5月至2023年5月上海交通大学医学院附属新华医院心胸外科重症监护室心脏外科术后的重症患者178例,采用随机数字表法将其分为对照组88例和观察组90例,对照组采用常规EN喂养方案,观察组采用早期间断EN喂养方案。比较两组患者EN耐受性指标、喂养中断情况、营养相关结局指标及患者预后指标。结果实施EN期间,观察组腹胀、腹泻、恶心呕吐(或反流)、喂养中断率、中断时间均低于对照组,差异有统计学意义(P<0.05);早期EN 7 d后观察组热卡达标率87.8%,明显高于观察组的22.5%,差异有统计学意义(P<0.05),观察组患者营养相关指标(血清前白蛋白、血红蛋白、实际摄入营养液体量)均高于对照组,差异均有统计学意义(P<0.05),观察组机械通气时间及重症监护室滞留时间均明显低于对照组,差异有统计学意义(P<0.05),两组患者总住院时间差异无统计学意义(P>0.05)。结论早期间断EN方案可改善患者喂养不耐受症状,减少喂养中断次数及时间,提高心脏外科术后重症患者热卡达标率,改善患者营养状态,促进患者预后及转归。

Objective To explore the effect of early intermittent enteral nutrition(EN)in critically ill patients after cardiac surgery.Methods We developed an early EN feeding regimen for critically ill patients after cardiac surgery.A prospective analysis was conducted on 178 critically ill patients admitted to the Cardiothoracic Surgery Intensive Care Unit of a tertiary hospital in Shanghai from May 2022 to May 2023.They were divided into the control group(n=88)and the observation group(n=90)using a random number table method.The control group received routine EN feeding,while the observation group received early intermittent EN feeding.Comparison between groups was performed in terms of the tolerability and interruption of EN administration,nutrition related outcome indicators,and prognosis indicators.Results The observation group had significantly lower rates of abdominal distension,diarrhea,nausea and vomiting(or reflux),and EN interruption,as well as shorter duration of EN interruption,compared to the control group(P<0.05).After 7 days of early EN,87.8%of patients in the observation group met the calorie goal,which was significantly higher than that of 22.5%in the observation group(P<0.05).The nutritional related indicators(serum prealbumin,hemoglobin,actual intake of nutritional fluids)were also better in the observation group patients compared to the control group(P<0.05).The duration of mechanical ventilation and length of ICU stay in the observation group were significantly shorter than those in the control group,with statistical significance(P<0.05).There was no significant difference in the length of hospital stay between the two groups.Conclusion Early EN program can improve the symptoms of feeding intolerance in patients,reduce the occurrence and duration of feeding interruption,increase the rate of calorie goal fulfillment,improve nutritional status,and promote patient recovery and outcome in critically ill patients after cardiac surgery.