肠内外营养对危重患者脏器功能影响的对比研究

目的探讨肠内外营养支持治疗对危重肺部感染患者内脏功能的保护作用。方法将42例重症监护室（ICU）重症肺部感染患者随机分为肠内营养（EN）组、静脉营养组和对照组，每组14例。给予相应治疗后7d观察患者血清丙氨酸转氨酶（ALT）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、血尿素氮（BUN）、白细胞计数（WBC）的变化及消化道出血发生率。结果对照组ALT、WBC均明显高于EN组和静脉营养组，PaO2明显低于EN组和静脉营养组（P均〈0．05）；EN组和静脉营养组间的ALT、WBC及PaO2差异均无显著性。对照组和静脉营养组消化道出血发生率均为42．9％，明显高于EN组的21．4％（P均〈0．05）。3组患者血BUN及PaCO2则无明显变化（P均〉0．05）。结论重症肺部感染患者及早给予EN比静脉营养和单纯葡萄糖供能要优越得多，有助于保护胃肠道和其他重要器官功能，防止肠道细菌及毒素移位，减轻全身炎症反应，防止多脏器功能不全发生。

Comparative study on influence of enteral and parenteral nutrition on organ function in critically ill patients

OBJECTIVE: To evaluate the protective effect of enteral nutrition on organ function in critically ill patients. METHODS: Forty-two critically ill patients were randomly divided into enteral nutrition group (n=14), total parenteral nutrition group (n=14), and control group (n=14). The partial pressure of oxygen in artery (PaO(2)), partial pressure of carbon dioxide in artery (PaCO(2)), white blood cell count (WBC) and the plasma contents of serum alanine aminotransferase (ALT), blood urea nitrogen (BUN), and the percentage of gastrointestinal haemorrhage were determined one week after the nutritional support was initiated. RESULTS: The WBC, the plasma contents of ALT, and the incidence of gastrointestinal haemorrhage were significantly higher in control group patients [(11.70+/-2.85)x10(9)/L, (59.69+/-20.32) U/L, 42.9%] than those in enteral nutrition group patients [(9.62+/-3.30)x10(9)/L, (40.68+/-22.11) U/L, 21.4%, P<0.05] and total parenteral nutrition group[(9.82+/-3.50)x10(9)/L, (40.98+/-21.87) U/L, P<0.05, 42.9%], However, PaO(2) in control group patients (62.78+/-4.95) mm Hg was markedly lower than those in enteral nutrition group and parenteral nutrition group patients [(80.85+/-14.03) mm Hg, (79.88+/-13.73) mm Hg, both P<0.05]. There was no significant difference in PaCO(2) and the plasma contents of BUN among the three groups 1 week after treatment were given (all P>0.05). CONCLUSION: Early stage enteral nutrition could well surpass total parenteral nutrition. It is conducive to protecting gastrointestinal function, preventing bacterial translocation, alleviating systemic inflammatory response and subsequent multiple organ failure among critically ill patients.