摘要
目的观察肠内营养对危重病机械通气患者的临床疗效。方法78例需机械通气患者,肠内营养组42例,予以能全力(荷兰Nutricia公司)每日1000ml鼻饲;对照组36例,予以普通流质每日1000 ml鼻饲(250ml,每日4次)。观察治疗前和治疗后3、7、14d 2组患者血清总蛋白、白蛋白、肌酐身高指数、免疫球蛋白、淋巴细胞计数、氮平衡、氧合指数(PaO_2/FiO_2)、呼吸机参数、血常规以及APACHEⅡ评分、呼吸机相关性肺炎发病率、28d存活率、脱机成功率和平均住院天数等临床指标的变化。结果与治疗前比较,肠内营养组治疗3d时差异无统计学意义,治疗7和14d后各指标差异均有统计学意义(P<0.05或0.01);对照组治疗前、后差异均无统计学意义(均P>0.05)。2组患者呼吸机相关性肺炎发病率、28d存活率、脱机成功率和平均住院天数比较差异均有统计学意义(均P<0.05)。结论鼻饲肠内营养可以改善危重病机械通气患者营养状况,促进蛋白质合成,纠正负氮平衡,改善机体免疫机能,增强呼吸肌功能,缩短机械通气时间,减少并发症的发生率,降低平均住院天数。
Objective To investigate the clinical effects of enteral nutrition in critically serious patients requiring mechanical ventilation. Methods 78 patients requiring mechanical ventilation were randomly divided into two groups：Group A （n = 42 ） were administered nutrison fibre 1000 ml a day; Group B （n = 36 ） were administered common liquid diet 1000 ml a day. The changes of serum total protein, blood album, index of creatinine stature, immune globulin,lymphocyte count, nitrogen balance, oxgenation index （ PaO2/FiO2 ）, ventilation parameter, blood routine, acute physiology and chronic health evaluation （ APACHE ） 11 , incidence of ventilator-associated pneumonia, survival rate for 28 days, ratio of off line and days in hospital were investigated. Results There were little changes of serum total protein, blood album, index of creatinine stature, immune globulin, lymphocyte count, nitrogen balance （PaO2/FiO2 ）,ventilation parameter, blood routine, APACHE 11 for all patients before intervention and three days later（ P 〉 0.05 ）. The incidences of serum total protein, blood album, index of creatinine stature, immune globulin, lymphocyte count,nitrogen balance （ PaO2/FiO2 ）, ventilation parameter, blood routine, APACHE 11 were improved statistically in patients of Group A on the 7th day （ P 〈 0.05 ） and changed more significantly on the 14th day （ P 〈 0. 01 ） respectively. However the indices for patients of Group B changed little both in seven days and fourteen days later （ P 〉 0.05 ）. Incidence of ventilator-associated pneumonia 28 d-survival rate were ratio of off line and mean hospitalization day were significantly different （ P 〈 0.05 ） between groups. Conclusion Enteral nutrition administered in critically serious patients requiring mechanical ventilation may improve the nutritional status, promote protein synthesis,improve immundogie function respiratory muscular strength, shorten the duration of the mechanical ventilation and decrease the length of hospital stay.
出处
《中国综合临床》
北大核心
2007年第7期640-642,共3页
Clinical Medicine of China
基金
全军医学科学技术研究"十五"计划面上课题(04MA023)
关键词
呼吸机相关性肺炎
肠内营养
机械通气
Ventilator-associated pneumonia
Enteral nutrition
Mechanical ventilation
