摘要
目的分析较低热量的代谢营养支持在老年ICU病人临床应用的有效性和安全性.方法收集2001年4月～2005年4月入住ICU≥10天且营养支持≥7天的110例老年ICU病人实施代谢营养支持的资料,分析代谢营养支持维持老年ICU病人营养状况的有效性,总结各种并发症的发生率,并分析肠内营养(EN)和肠外营养(PN)的应用比例及其所占比重与各种相关并发症和预后的关系.结果代谢营养支持的途径:完全肠道营养(TEN)占28.2%,完全肠道外营养(TPN)占23.6%,EN+PN占48.2%;代谢营养支持能显著改善氮平衡并维持在较低的水平(P＜0.05),血清前白蛋白(PA)较支持前升高(P＜0.05),而白蛋白(ALB)、血红蛋白(HGB)等有下降趋势(P＞0.05);胃肠道及代谢并发症在较低水平(10%左右).病人的预后与能否较好地应用EN相关,不能耐受EN而行TPN者感染、肝功能损害及多器官衰竭(MOF)的发生率较高(P＜0.05或＜0.01),住ICU的天数较长且在ICU的病死率较高(P＜0.05或＜0.01).结论对老年ICU病人行较低热量的代谢营养支持能在低水平维持氮平衡,且胃肠道及代谢性并发症的发生率较低;老年危重病人肠功能维护得好,EN进行得顺利,对病人的预后有积极意义;以EN+PN互为补充的代谢营养支持可能是老年ICU病人最为有效和安全的营养支持方式.
Objective To analyze the effectiveness and security of low calorie metabolism support on aged ICU patients. Method Data of 110 cases（from Apr. 2001 to Apr. 2005 ） with ≥ 10 days of stay in ICU and ≥7 days of metabolism nutrition support were collected. The effectiveness of metabolism nutrition support on the nutrition maintain of gerontal patients was analyzed, the incidence of varyious complications was summarized, and the application ratio of EN and PN as well as the relationship of the ratio with various related compliations and prognosis were analyzed. Results The percentages of TEN,TPN and EN ＋ PN were 28.2% ,23.6% and 48.2%. Metabolism support could significantly improve nitrogen balance to lower level（ P 〈 0.05 ）. Concentration of serum PA significantly increased（P 〈0.05） ,while ALB and HGB tended to decrease（P 〉0.05）. The incidence of gastrointestinal and metabolic complications was low（ about 10% ）. Good tolerance of EN seemed to lead to better prognosis of the patients for there were higher rates of infection, liver malfunctions and MOF（ P 〈 0.05 or 〈 0.01 ）, higher mortality and longer stay in ICU （P 〈 0.05 or 〈 0.01 ）in those patients who failed to receive EN support and had to receive TPN support. Conclusions Metabolism support with lower energy intake can maintain nitrogen balance on lower level and lead to less incidence of gastrointestinal and metabolic complications. If their enteral functions are preserved well, good tolerance of EN may lead to better prognosis of the old critially ill patients. EN ＋ PN may be the most effective and safest nutrition suport way for aged ICU patients.
出处
《现代诊断与治疗》
CAS
2005年第6期328-331,共4页
Modern Diagnosis and Treatment
关键词
代谢支持
危重病人
老年病人
Metabolism support
Critically ill patients
Gerontal patients
