危重患者早期肠内营养相关并发症分析

Early enteral nutrition-related complications in critically ill patients

目的 观察综合性ICU危重症患者早期肠内营养支持中 ,相关并发症的发生及其相关因素。方法 119例入住ICU接受早期肠内营养支持患者 ,入ICU后根据 2 4小时内各项监护指标及血常规、血气分析及肝肾功能检查 ,进行APACHE Ⅱ评分。观察肠内营养量、速度、血清白蛋白 (Alb)及肠内营养的耐受情况。总结各种肠内营养并发症的发生率。结果 随APACHE Ⅱ评分的增加 ,肠内营养耐受的最大维持量降低、达最大维持量的时间延长、相关并发症的发生率增加。腹泻发生与Alb水平呈负相关 ,与APACHE Ⅱ评分呈正相关。肠内营养并发症中以腹泻最为常见。结论 肠内营养相关并发症与疾病严重程度、血清蛋白水平等因素相关 ,一些危重患者无法过渡到完全肠内营养 (TEN) ,而需以静脉营养 (PN) +肠内营养 (EN)形式实现营养支持。

Objective To observe the incidence of early enteral-nutrition-related complications in ICU patients and its associated factors. Methods 119 ICU patients receiving enteral nutrition were monitored, whose 24 h monitoring indexes, blood analysis, blood gas analysis and the detection of the function of liver and kidney were all carried out for APACHE-II scoring.Enteral feeding amount and speed, serum albumin (Alb) and interal feeding tolerance were observed. The incidence rate of all kinds of complications related to enteral nutrition was summarized. Results The patients with higher APACHE-II grades had lowered total feeding amount, prolonged feeding duration, and higher incidence rate of complications. The diarrhea was negatively related with serum Alb level and positively related with APACHE-II scoring which was the most common one among the enteral nutrition-related complications. Conclusion Enteral nutrition-related complications are related with the severity of disease and Alb level. Some critically ill patients can not sustain the total enteral nutrition(TEN), so parenteral nutrition(PN)+EN is the necessary choice of nutritional support for them.