早期和晚期肠内营养在机械通气患者中的比较

目的评价早期肠内营养对ICU机械通气患者营养状况和并发症的影响。方法选择ICU需要肠内营养支持机械通气患者66例,均在入住ICU后48 h内,给予胃镜下空肠置管。随机分为两组,早期肠内营养组33例,于24～48 h内行肠内营养;晚期肠内营养组33例,于入住ICU 48 h后开始肠内营养。比较两组患者的营养参数(白蛋白、前白蛋白和转铁蛋白)、肠内营养耐受性及并发症(腹泻腹胀、肝功能受损、高血糖、应激性溃疡、肺炎和心力衰竭)的发生率、机械通气时间、撤机时间等各项指标。结果两组患者前白蛋白和转铁蛋白较营养支持前升高(P<0.05);早期肠内营养组患者机械通气时间、平均住ICU时间较晚期肠内营养组为少(P<0.01)。两组肠内营养耐受性及并发症发生率比较差异无统计学意义(P>0.05)。结论早期肠内营养能及时改善重症患者的营养状况,缩短机械通气时间和住ICU时间。

Early and late enteral nutrition in critical ill patients on ventilation

【Objective】 To evaluate the effect of early enteral nutrition on nutritional status and complication in patients with ventilation.【Methods】 66 critically illed patients with mechanical ventilation were randomly divided into early enteral nutrition group(EEN,33 cases) and late enteral nutrition group(LEN,33 cases).All patients’ feeding tube was indwelled beyond post-pylorica with the help of gastroscope.The level of serum albumin,prealbumin and trasferrin were assayed for 2 weeks since the onset of ventilation.Observe patients’ tolerances for enteral nutrition,complication,lasting time of ventilation.【Results】 The nutritional status of 2 groups were improved;there were no difference in gastroenternal tolerance,complication and rate of weaning between two groups;compared with the late enteral nutrition group,ventilation time and ICU length of stay was shorter in early enteral nutrition group than the late enteral nutrition group(P <0.05).【Conclusion】 Early nutrition can improve nutritional status and outcomes of critically illed patient on ventilation and decreasing the ICU length of stay.