摘要
目的研究不同肠内营养方式对机械通气患者营养状况、肠内营养耐受性、并发症及呼吸机相关性肺炎的影响。方法选择64例重症呼吸衰竭机械通气患者为观察对象,随机分为两组,鼻胃管组和鼻肠管组,各32例;两组均给予肠内营养制剂,不足部分由肠外营养补充;观察两组患者在治疗前后营养指标的演变,比较两组患者肠内营养并发症、肠道耐受性、呼吸机相关性肺炎的发生率、机械通气时间和住ICU时间。结果治疗前后的前白蛋白鼻胃管组患者为(161.8±19.1)、(193.7±27.0)mg/L,鼻肠管组患者为(182.5±29.4)、(214.32.4)mg/L;治疗前后转铁蛋白鼻胃管组患者为(228.3±42.1)、(266.3±23.1)mg/L,鼻肠管组患者为(223.1±26.2)、(272.6±25.5),治疗前后比较,差异均有统计学意义(P<0.05);鼻胃管组与鼻肠管组:腹胀腹泻发生率为25.0%、15.6%,高血糖发生率为28.1%、6.2%,应激性溃疡发生率为6.2%、3.1%,肝损害发生率为6.2%、3.1%,差异均无统计学意义;鼻肠管组反流率及呼吸机相关性肺炎发生率均为6.2%,低于鼻胃管组的31.2%、18.7%(均P<0.05);鼻肠管组机械通气时间、住ICU时间为(6.5±1.1)、(8.9±1.8)d,短于鼻胃管组的(9.8±2.3)、(13.4±2.4)d,差异均有统计学意义(P<0.01)。结论肠内营养对机械通气患者的营养状况的改善有帮助;经鼻肠管方式行肠内营养的机械通气患者肠道耐受性好,呼吸机相关性肺炎发生率低。
OBJECTIVE To evaluate the effect of different nutrition approaches on the nutritional status, enteral tolerance and incidence of ventilator-associated pneumonia of the patients with mechanical ventilation. METHODS A total of 64 patients with mechanical ventilation were randomized into 2 groups： naso-gastric tube group and naso-postpyloric tube group, with 32 cases in each;both groups received enteral formulations, the shortage part was supplemented by the parenteral nutritions the change of nutrition indicators before and after the treatment was observed, the nutritional status, complications and tolerance of enteral nutrition, the incidence of ventilator- associated pneumonia, and the duration of mechanical ventilation and ICU stay were compared. RESULTS The prealbumin of the naso-gastric tube group before and after the treatment were （161.8±19.1）mg/L, and （193.7± 27. 0）mg/L, the naso-postpyloric tube group （182.5±29.4）mg/L and （214.32.4）mg/L; the transferrin of the naso-gastric tube group before and after the treatment were （228.3 ± 42.1）mg/L and （266.3 ± 23.1）mg/L, the naso-postpyloric tube group （223.1±26.2） and （272.6±25.5）, the differences were statistically significant （P 〈0.05） ; the incidence rates of abdominal distension and diarrhea of the naso-gastric group and the naso-postpylori e group were 25.0% and 151 6%, high blood sugar 28.1% and 6.2%, stress ulcer 6.2% and 3.1%, liver damage 6.2 % and 3.1%, the differences were not statistically signifieant; the incidence rates of both reflux and ventilator- associated pneumonia of the naso-postpylorie tube group were 6. 2%, lower than 31. 2% and 18. 7% of the naso-gastric tube group （P〈0.05）; the ventilation duration and the ICU stay were shorter in naso-postpyloric tube group（6.5±1. 1）d and （8. 9±1.8） d than naso--gastric tube group （9. 8±2. 3）d and（13.4±2. 4）d （P〈0.01）. CONCLUSION Enteral nutrition can improve the nutritional status of patients with mechanicalventilations the enteral nutrition through naso-postpyioric tube has a better intestinal tolerance and is with lower incidence of ventilator-associated pneumonia.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2012年第16期3479-3481,共3页
Chinese Journal of Nosocomiology
关键词
肠内营养
鼻肠管
鼻胃管
呼吸机相关性肺炎
Enteral nutrition
Naso-gastric tube
Naso-postpyloric tube
Ventilator-associated pneumonia
