摘要
目的探讨早期肠内营养(EEN)对外科脓毒症患者预后的影响。方法回顾性分析66例外科脓毒症患者资料,按肠内营养(EN)方式分为EEN组(34例,入院当日始行EN)、DEN组(15例,第4天始行EN)和TPN组(17例,全肠外营养)。EEN组和DEN组予胃管或空肠造瘘管持续泵注,TPN组予静脉输注。比较三组治疗第7天病情严重指标以及治疗后的预后指标。结果EEN组急性生理和慢性健康评分Ⅱ(APACHEⅡ)、序贯性脏器功能衰竭评分(SOFA)、降钙素原(PCT)浓度、乳酸水平和腹腔高压发生率均低于其他两组,而白蛋白水平高于其他两组(P<0.05),DEN组APACHEⅡ评分、PCT浓度和乳酸水平低于TPN组(P<0.05)。EEN组病死率、多器官功能障碍综合征(MODS)发生率、多次手术率和机械通气时间均低于其他两组(P<0.05);DEN组病死率和MODS发生率低于TPN组(P<0.05)。结论 EEN能显著改善外科脓毒症患者的病情,降低病死率。
Objective To explore the effect of early enteral nutrition（EN） on the prognosis of patients with surgical sepsis. Methods Sixty-six patients with surgical sepsis were analyzed retrospectively,who were assigned into three groups of A（34 cases, treated with EN on the day of admission）, B（15 cases, treated with EN on the 4th day after admission） and C（17 cases, treated with total parenteral nutrition）. EN was performed by continuously pumping via gastric tube or fistula of jejunostomy in groups of A and B. The indicators reflecting the severity on the 7th day of treatment and the prognosis after treatment were compared among three groups. Results The scores of acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） and sequential organ failure assessment （SOFA）, the levels of procalcitonin（PCT） and lactate, and the incidence rate of intra-abdominal hypertension were lower, but the level of albumin was higher, in group A than those in groups of B and C（P〈0. 05）. The scores of APACHE Ⅱ and SOFA and serum PCT and lactate were lower in group B than those in group C （P〈0. 05 ）. The mortality, incidence rates of multiple organ dysfunction syndrome（MODS） and multiple operation, and the time of mechanical ventilation were lower in group A than those in groups of B and C（P〈0. 05）. The mortality and incidence rate of MODS were lower in group A than those in group C （P〈0. 05）. Conclusion Early EN can remarkably improve the severity and reduce the mortality of patients with surgical sepsis.
出处
《江苏医药》
CAS
北大核心
2013年第19期2291-2293,共3页
Jiangsu Medical Journal
关键词
脓毒症
肠内营养
肠外营养
Sepsis
Enteral nutrition
Parenteral nutrition
