腹部外科疾病并发多器官功能障碍综合征代谢特点及分阶段营养支持治疗

Characteristics of metabolism and nutrition support during different periods in abdominal surgical diseases complicated by multiple organ dysfunction syndrome

目的 :探讨用分阶段代谢营养支持治疗腹部外科疾病并发多器官功能障碍综合征 (MODS)的有效性。方法 :1994 2 0 0 0年 11月收治的 6 6例 MODS患者在综合治疗基础上 ,32例采用分阶段代谢营养支持 ;34例采用常规治疗。分阶段代谢营养支持治疗方法为 :第一阶段即患者的高度应激状态得到初步处理、但胃肠功能仍处在明显障碍时 ,应采用完全胃肠外营养支持 ;第二阶段即病情有缓解 ,可肠内、肠外营养同时进行 ;第三阶段即病情得到完全控制、胃肠道功能完全恢复时 ,逐步过渡直至全部应用肠内营养。结果 :分阶段代谢营养支持治疗组 2 3例抢救成功 ,9例死亡 ,病死率 2 8.12 % ;常规治疗组 19例救治成功 ,15例死亡 ,病死率为4 4 .11%。结论 :腹部外科疾病并发 MODS时的代谢特点主要是 :一方面机体处在代谢紊乱及营养素利用障碍状态 ,急需给予补充 ;另一方面由于多器官功能障碍时 ,不能有效地利用营养素及排出代谢产物。分阶段代谢营养支持治疗是阻止病情进一步发展的关键措施之一 ,如急于求成 ,势必要加重病情。完全的代谢营养支持治疗确能保护和支持器官的功能 ,这对其他综合治疗措施的实施有着重要的临床意义。

Objective:To evaluate the characteristics of metabolism in patients with abdominal surgical diseases complicated by multiple organ dysfunction syndrome(MODS),and the effects of nutritional support in different periods.Methods:In 32 patients out of 66 patients suffering from MODS nutritional support was given through different channels according to different disease stages.In the first period,total parenteral nutrition(TPN) should be implemented when acute stress was just over and the functions of gastrointestinal system was still in a bad condition.During the second period,TPN and enteral nutrition(EN) could be instituted at the same time,when the state of illness was under control.In the third period,if the condition of the patients was totally controlled,and the function of stomach and intestine had completely recovered,total EN could be given after a transitional period.Results:In these 32 patients,23 patients were cured successfully and 9 patients died;the mortality was 28 12%.In those 34 patients treated with conventional methods,19 patients were cured while 15 patients died,and the mortality was 44 11%( P <0 01).Conclusion:When MODS occurred,metabolism is disturbed, and the body is unable to utilize the supplied nutrients and to get rid of the catabolic products.There fore,it seemed to be necessary to give nutrition support in different manner during different periods of the disease.Otherwise,the disease might be aggravated.