幽门后喂养方式应用于危重患者早期肠内营养对肠内营养耐受性及临床预后的影响

Effect of Postpyloric Feeding on Early Enteral Nutrition Tolerance and Clinical Prognosis in Critically Ill Patients

目的探究早期肠内营养幽门后喂养干预应用于危重患者的临床效果。方法回顾性分析81例危急重症患者临床资料,采用幽门后喂养者纳入幽门后组(n=46),幽门前喂养者纳入幽门前组(n=35)。比较干预前及干预3 d、1周后两组营养状态[患者自评-主观整体评估(PG-SGA)]、病情危重程度[急性生理和慢性健康评估系统Ⅱ(APACHEⅡ)]变化,分析1周内营养不耐受症状发生率及预后情况差异。结果干预3 d、1周后,两组PG-SGA、APACHEⅡ评分均较干预前出现显著下降,且幽门后组明显低于同一时间幽门前组(P<0.05)。干预1周内,幽门后组腹胀、恶心/呕吐、胃潴留发生率均明显低于幽门前组(P<0.05);而两组腹泻、消化道出血发生率比较,差异均无统计学意义(P>0.05)。干预开始后30 d内,幽门后组医院获得性肺炎发生率明显低于幽门前组(P<0.05);而两组泌尿系感染、脓毒性休克、多器官衰竭发生率及病死率比较,差异均无统计学意义(P>0.05)。存活患者中,幽门后组平均住重症监护病房(ICU)时间、住院时间均明显少于幽门前组(P<0.05)。结论采用幽门后喂养能一定程度确保患者营养耐受性与早期肠内营养干预的安全性、有效性,对患者预后康复有积极意义。

Objective To explore the clinical effects of postpyloric feeding in critically ill patients.Methods The clinical data of 81 critically ill patients were retrospectively analyzed.The patients with postpyloric feeding were included in postpyloric group(n=46),and the patients with prepyloric feeding were included in prepyloric group(n=35).Nutritional status[Patient-Generated Subjective Global Assessment(PG-SGA)]and severity of illness[Acute Physiology And Chronic Health Evaluation II(APACHEII)]were compared between the two groups before intervention and after 3 d and one week of intervention,and the incidence rate of nutrition intolerance symptoms and prognosis were analyzed within one week.Results After 3 d and one week of intervention,the scores of PG-SGA and APACHE II in the two groups were significantly lower than those before intervention,and the scores in postpyloric group were significantly lower than those in prepyloric group at the same time(P<0.05).Within one week of intervention,the incidence rates of abdominal distension,nausea/vomitin,and gastric retention in postpyloric group were significantly lower than those in prepyloric group(P<0.05).There were no significant differences in the incidence rates of diarrhea and gastrointestinal bleeding between the two groups(P>0.05).Within 30 d after the start of intervention,the incidence rate of acquired pneumonia in postpyloric group was significantly lower than that in prepyloric group(P<0.05).There were no statistically significant differences in the incidence rates of urinary tract infection,septic shock and multiple organ failure and mortality rate between the two groups(P>0.05).Among the surviving patients,the average intensive care unit(ICU)stay and hospital stay in postpylorus group were significantly less than those in prepyloric group(P<0.05).Conclusion Postpyloric feeding can ensure the safety and effectiveness of nutritional tolerance and early enteral nutrition intervention to a certain extent.It has positive significance for the prognosis and rehabilitation of patients.