鼻空肠管与鼻胃管肠内营养支持在急诊ICU机械通气患者中的应用效果对比

目的 对比鼻空肠管与鼻胃管肠内营养支持在急诊ICU机械通气患者中的应用效果。方法 70例急诊ICU机械通气患者随机分为两组。对照组留置鼻胃管进行肠内营养支持,观察组留置鼻空肠管进行肠内营养支持。比较两组的营养状况和并发症。结果 观察组的达目标喂养量所需时间短于对照组（P <0.05）。干预后,观察组的HB、 PAB和ALB水平均高于对照组（P <0.05）。观察组的胃肠道并发症总发生率为5.71%,低于对照组的28.57%(P <0.05)。结论 与鼻胃管肠内营养支持相比,鼻空肠管肠内营养支持能够快速改善急诊ICU机械通气患者的营养状况,减少胃肠道并发症的发生。     

床旁空肠营养管徒手置入技术在危重症病人营养治疗中的应用研究

目的:探讨床旁空肠营养管徒手置入技术在危重症病人肠内营养(EN)治疗中的安全性、有效性和实用性. 方法:鼻空肠管组病人采用美国CORPAK公司CORFLO导管置入行鼻空肠营养29例.鼻胃管组采用普通胃管置入行EN支持30例.观察鼻空肠管组置管成功率,置管时间和不良反应.对比观察两组病人血清清蛋白(ALB)、前清蛋白(PA)、血红蛋白(Hb)、APACHEⅡ评分、入住ICU时间、置管费用和ICU总费用等指标的变化,以及反流、腹胀、腹泻、应激性溃疡和吸入性肺炎等并发症的发生率. 结果:床旁经鼻空肠营养管徒手置入成功率为93.1％,置管时间为(19.3-6.8) min,无不良反应.鼻空肠管组病人营养指标和APACHEⅡ评分改善明显,且入住ICU时间、ICU总费用和并发症的发生率均低于对照组. 结论:床旁空肠营养管徒手置入技术在危重症病人EN支持治疗中,具有操作简单、安全、置管成功率高、并发症低、病人营养状况改善明显的优点.     

分析螺旋型鼻空肠管在ICU重症患者的营养支持治疗中的应用

目的:研究ICU重症患者营养支持治疗中螺旋型鼻空肠管的应用效果。方法:以我院2017年11月5日至2018年4月2日66例ICU重症患者为研究对象,根据完全随机原则,将其均分为对照组及观察组。两组均予以肠内营养支持,对照组留置鼻胃管,观察组使用螺旋型鼻空肠管。观察两组干预前后营养状况及不良事件发生情况。结果:观察组干预后血清白蛋白、前蛋白、血红蛋白分别为(44.28±3.58)g/L、(280.12±3.95)mg/L、(11.40±0.39)g/L,相比对照组显然更高,P0.05;观察组不良事件发生概率低于对照组,但两者差异性不大,P0.05。结论:ICU重症患者行肠内营养过程中,螺旋型鼻空肠管应用效果更佳,可减少危险事件发生风险。     

早期肠内营养支持对ARDS患者的免疫功能影响

目的观察早期肠内营养支持对ARDS患者的免疫功能影响以及对最终死亡率的影响.方法ARDS患者在开始机械通气分为肠内营养组和对照组,肠内营养组在机械通气当天即通过鼻胃管或鼻肠管给予鼻饲合成营养素,对照组则延迟至7天以后应用肠内营养.然后统计各项指标情况.结果治疗两周后及存活者出院时观察组与对照组相比在总蛋白、淋巴细胞数量、以及CD3和CD4水平均有明显升高,而CD8变化不大.肠内营养组与对照组相比在机械通气时间(平均12.8±2.1天、17.6±3.6天)、住ICU时间(平均21.5±4.6天、31.5±3.4天)均明显缩短.两组最终病死率有明显差异,肠内营养组为27.8%,对照组为35.7%.两组营养支持相关并发症发生率无明显差异.结论早期肠内营养支持可提高ARDS患者的免疫功能,提高总蛋白水平,降低最终病死率,缩短机械通气时间和住ICU时间,从而降低患者的医疗费用.     

鼻空肠管与鼻胃管在危重患者早期肠内营养的应用比较

目的比较危重患者经鼻空肠管与经鼻胃管实施早期肠内营养的临床应用效果,选择一条更有效的肠内营养途径。方法对37例危重患者采用经鼻空肠管早期肠内营养,观察开始实施时间、达到预计能量需要时间以及并发症等,并与经鼻胃管进行比较,评价经鼻空肠管早期肠内营养的有效性和安全性。结果危重患者早期肠内营养的开始时间及达到预计能量所需时间与营养管途径有关,经鼻空肠管肠内营养的开始时间与鼻胃管比较U=4.497,P<0.01;达到预计能量所需时间比较U=4.040,P<0.01,差异均有统计学意义;并发症比较χ2=5.572,P<0.05,差异有统计学意义。结论危重患者早期肠内营养经鼻空肠管途径比经鼻胃管更为安全有效,并能将实施肠内营养的时间显著提前。     

危重病人留置鼻空肠管行早期肠内营养

目的:探讨留置螺旋形鼻空肠管行早期肠内营养在危重病人中的应用价值.方法:对该院ICU收治的30例危重病人随机分为A组和B组,每组各15例.分别留置螺旋形鼻空肠管和鼻胃管进行早期肠内营养.入科后第1天和第8天分别测定血液T淋巴细胞亚群变化,并进行比较.结果:入科后第1天,A、B组间CD3 、CD4 和CD4 /CD8 ,差异无显著性意义(P＞0.05);第8天A组CD3 、CD4 和CD4 /CD8 比第1天均显著增加(P＜0.05),惟CD8 无显著差异(P＞0.05);而B组上述指标无明显变化(P＞0.05).当天两组间CD3 、CD4 和CD4 /CD8 也存在显著差异(P＜0.05),惟CD8 无显著差异(P＞0.05).而且A组胃内潴留、急性胃黏膜病变等并发症显著减少(P＜0.05);A组在ICU时间较B组缩短(P＜0.05).结论:危重病人留置鼻空肠管行早期肠内营养对细胞免疫有积极影响,能减少并发症的发生,并能缩短入住ICU的时间.     

不同肠内营养方式对呼吸机相关性肺炎的影响

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.     

经鼻空肠管早期肠内营养在重症胸外伤老年病人中的应用

目的:探讨经鼻空肠管早期肠内营养(EEN)在伴呼吸功能衰竭的重症胸外伤老年病人中的应用.方法:将42例伴呼吸功能衰竭的重症胸外伤老年病人随机分为试验组和对照组.试验组经鼻空肠管行EEN;对照组病人早期给予全胃肠外营养(TPN)支持,比较两组营养、炎症、免疫和临床观察各项指标.结果:两组病人在机械通气开始时营养、炎症、免疫指标均无显著性差异.经营养支持后,试验组病人营养指标和免疫功能指标均优于对照组(P＜0.05,P＜0.01),炎症指标均低于对照组(P＜0.05,P＜0.01);病死率、肺部感染率和机械通气时间显著低于对照组(P＜0.01).结论:伴呼吸功能衰竭的重症胸外伤老年病人经鼻空肠管EEN安全可行,可提高免疫功能,改善营养状况,减轻炎症反应,减少伤后并发症的发生率,从而提高生存率.     

实时超声辅助联合间断注水注气法在危重病人鼻空肠管留置中的应用

目的:评价床旁实时超声辅助联合间断注水注气法在危重病人鼻空肠管留置中的临床效果。方法:选择2017年7月1日至2019年4月30日西安交通大学第一附属医院外科ICU需要进行肠内营养管留置的危重病人进行回顾性分析,根据留置方式分为试验组及对照组,试验组采用实时超声辅助联合间断注水注气留置法,对照组采用徒手盲插留置法。比较两组操作时间、成功率及并发症情况。结果:共计50例病人纳入研究,其中试验组25例,对照组25例。试验组在操作时间上差异无统计学意义[(23.82±8.91) vs (22.35±7.62) min,P=0.538);试验组一次置管成功率显著优于对照组(92%vs 64%, P=0.037);两组病人操作过程中均未出现明显并发症。结论:床旁实时超声辅助联合间断注水注气法在危重病人鼻空肠管留置应用中具有安全可行的特点,值得临床广泛开展。     

内镜下放置鼻空肠营养管的方法和营养效果分析

目的:探讨分析内镜下放置空肠营养管的方法和营养支持效果。方法:选择106例需放置空肠营养管的病人随机分为观察组54例和对照组52例。此外,选择同期行鼻胃管肠内营养病人43例作为鼻胃管组。对照组采用传统内镜下经鼻空肠营养管置管术;观察组采用改良后内镜下经鼻空肠营养管置管术;鼻胃管组采取常规鼻胃管肠内营养。比较三组病人手术时间、一次性置管成功率、置管后并发症发生率以及病人置管后营养指标变化情况。结果:观察组和鼻胃管组病人手术时间显著短于对照组(P0.05),一次性置管成功率显著高于对照组(P0.05)。三组病人置管后并发症发生率无显著性差异(P0.05)。三组病人置管后血红蛋白、血清清蛋白以及前清蛋白水平均较治疗前显著改善(P0.05)。观察组和对照组病人置管前后营养指标比较均无显著性差异(P0.05),而鼻胃管组病人置管后血红蛋白、血清清蛋白和前清蛋白水平显著低于观察组和对照组(P0.05)。结论:改良内镜下鼻空肠管置管术能有效缩短置管手术时间,提高一次性置管成功率,降低病人置管手术的痛苦。置管后病人营养支持效果显著。     

Does Route of Full Feeding Affect Outcome among Ventilated Critically Ill COVID-19 Patients: A Prospective Observational Study

The outbreak of the new coronavirus strain SARS-CoV-2 (COVID-19) highlighted the need for appropriate feeding practices among critically ill patients admitted to the intensive care unit (ICU). This study aimed to describe feeding practices of intubated COVID-19 patients during their second week of hospitalization in the First Department of Critical Care Medicine, Evaggelismos General Hospital, and evaluate potential associations with all cause 30-day mortality, length of hospital stay, and duration of mechanical ventilation. We enrolled adult intubated COVID-19 patients admitted to the ICU between September 2020 and July 2021 and prospectively monitored until their hospital discharge. Of the 162 patients analyzed (52.8% men, 51.6% overweight/obese, mean age 63.2 ± 11.9 years), 27.2% of patients used parenteral nutrition, while the rest were fed enterally. By 30 days, 34.2% of the patients in the parenteral group had died compared to 32.7% of the patients in the enteral group (relative risk (RR) for the group receiving enteral nutrition = 0.97, 95% confidence interval = 0.88–1.06, p = 0.120). Those in the enteral group demonstrated a lower duration of hospital stay (RR = 0.91, 95% CI = 0.85-0.97, p = 0.036) as well as mechanical ventilation support (RR = 0.94, 95% CI = 0.89–0.99, p = 0.043). Enteral feeding during second week of ICU hospitalization may be associated with a shorter duration of hospitalization and stay in mechanical ventilation support among critically ill intubated patients with COVID-19.     

The Effects of Enteral Nutrition in Critically Ill Patients with COVID-19: A Systematic Review and Meta-Analysis

Background: Patients who are critically ill with COVID-19 could have impaired nutrient absorption due to disruption of the normal intestinal mucosa. They are often in a state of high inflammation, increased stress and catabolism as well as a significant increase in energy and protein requirements. Therefore, timely enteral nutrition support and the provision of optimal nutrients are essential in preventing malnutrition in these patients. Aim: This review aims to evaluate the effects of enteral nutrition in critically ill patients with COVID-19. Method: This systematic review and meta-analysis was conducted based on the preferred reporting items for systematic review and meta-Analysis framework and PICO. Searches were conducted in databases, including EMBASE, Health Research databases and Google Scholar. Searches were conducted from database inception until 3 February 2022. The reference lists of articles were also searched for relevant articles. Results: Seven articles were included in the systematic review, and four articles were included in the meta-analysis. Two distinct areas were identified from the results of the systematic review and meta-analysis: the impact of enteral nutrition and gastrointestinal intolerance associated with enteral nutrition. The impact of enteral nutrition was further sub-divided into early enteral nutrition versus delayed enteral nutrition and enteral nutrition versus parenteral nutrition. The results of the meta-analysis of the effects of enteral nutrition in critically ill patients with COVID-19 showed that, overall, enteral nutrition was effective in significantly reducing the risk of mortality in these patients compared with the control with a risk ratio of 0.89 (95% CI, 0.79, 0.99, p = 0.04). Following sub-group analysis, the early enteral nutrition group also showed a significant reduction in the risk of mortality with a risk ratio of 0.89 (95% CI, 0.79, 1.00, p = 0.05). The Relative Risk Reduction (RRR) of mortality in patients with COVID-19 by early enteral nutrition was 11%. There was a significant reduction in the Sequential Organ Failure Assessment (SOFA) score in the early enteral nutrition group compared with the delayed enteral nutrition group. There was no significant difference between enteral nutrition and parenteral nutrition in relation to mortality (RR = 0.87; 95% CI, 0.59, 1.28, p = 0.48). Concerning the length of hospital stay, length of ICU stay and days on mechanical ventilation, while there were reductions in the number of days in the enteral nutrition group compared to the control (delayed enteral nutrition or parenteral nutrition), the differences were not significant (p > 0.05). Conclusion: The results showed that early enteral nutrition significantly (p < 0.05) reduced the risk of mortality among critically ill patients with COVID-19. However, early enteral nutrition or enteral nutrition did not significantly (p > 0.05) reduce the length of hospital stay, length of ICU stay and days on mechanical ventilation compared to delayed enteral nutrition or parenteral nutrition. More studies are needed to examine the effect of early enteral nutrition in patients with COVID-19.     

Immunonutrition in the intensive care unit. A systematic review and consensus statement

OBJECTIVE: To systematically review the effects of enteral nutrition with pharmaconutrients-enriched diets in critically ill patients and to establish recommendations for their use. DATA SOURCES: Computerized bibliographic search of published research and citation review of relevant articles. STUDY SELECTION: Randomized clinical trials of critically ill patients treated with enteral nutrition comparing diets enriched with pharmaconutrients vs not enriched diets were included. Infectious complications and outcome variables (days on mechanical ventilation, ICU and hospital length of stay and mortality) were evaluated. Studies were classified in four subgroups according to the patient's primary diagnosis: surgical, trauma, burned or medical. DATA EXTRACTION: A group of experts in methodology performed data extraction and statistical processes. A global analysis of the studies was done and also a separate study for each subgroup. Results of the meta-analysis were discussed within a 'clinical group' of clinicians with experience in the nutritional support of ICU patients, in order to find agreement about recommendations for the use of pharmaconutrients-enriched diets in critically ill patients. RESULTS: Independent review of 267 articles identified 26 relevant primary studies. Global results indicate that there was a reduction in infection rate in the pharmaconutrition group, considering the appreciated lower incidence in abdominal abscesses (OR: 0.26, CI: 0.12-0.55) (P=0.005), nosocomial pneumonia (OR: 0.54, CI: 0.35-0.84) (P=0.007) and bacteremia (OR: 0.45, CI: 0.35-0.84) (P=0.0002). Also, patients treated with pharmaconutrition diets have a reduction in time on mechanical ventilation (mean 2.25 days, CI: 0.5-3.9) (P=0.009), ICU length of stay (mean reduction of 1.6 days, CI: 1.9-1.2) (P<0.0001) and hospital length of stay (mean reduction of 3.4 days, CI: 4.0-2.7) (P<0.0001). No effects were appreciated on mortality (OR: 1.10, CI: 0.85-1.42) (P=0.5). Nevertheless, the separate analysis for each subgroup showed that the reported beneficial effects were not the same for each patient population. Also, the clinician panel of experts identifies several problems in the published data about enteral pharmaconutrition in critically ill patients. In spite of the subgroup differences and of the problems detected, the clinician group considered that the appreciated results could support a Grade B recommendation for the use of these formulas in ICU patients. CONCLUSIONS: Considering the beneficial effects and the absence of detrimental ones, the use of diets enriched with pharmaconutrients could be recommended in ICU patients requiring enteral feeding. Nevertheless, more investigation is needed in this field in order to find the more appropriate population of patients that can benefit from this nutritional therapy.     

危重病人早期肠内营养的临床应用分析

目的:分析早期肠内营养在危重病人中的临床应用状况. 方法:回顾3年半中住ICU>10天的278例病人资料,分析各类病种及各种途径早期肠内营养的实施情况,观察开始时间、达到营养目标点时间、并发症等. 结果:87.1%的危重病人可早期给予肠内营养,早期肠内营养开始时间、达到营养目标点时间与营养途径有关. 结论:早期肠内营养在危重病人中可以实施,并可能有助于降低病死率.     

机械通气病人肠内营养应用时机的临床对照研究

目的:探讨早期肠内营养(EEN)对机械通气病人营养状态和临床疗效的影响. 方法:将118例行机械通气的重症病人随机分为早期EN组(机械通气开始后48 h内实施EN)和晚期EN组(机械通气开始48 h后实施EN),每组各59例.检测机械通气开始当天和治疗后第7天血清清蛋白、前清蛋白、转铁蛋白和氮平衡的变化.比较两组病人机...     

早期实施肠道内营养支持护理对ICU禁食危重症患者康复效果的影响

目的 探讨早期肠内营养支持护理对重症监护室（ICU）禁食危重患者病情恢复的影响。方法 选取2020年5月—2021年5月本院ICU病房收治的80例禁食危重患者作为研究对象,按照随机数字表法分为两组,各40例。对照组采取常规营养支持护理,观察组采取早期肠内营养支持护理,持续支持7 d。对比两组营养状态、恢复情况、急性生理与慢性健康状况（APACHEⅡ）评分。结果 干预后,观察组血清白蛋白（ALB）、转铁蛋白（TRF）、前白蛋白（PA）水平分别为（39.41±1.55）g/L、（1.49±0.24）g/L、（261.12±18.72）mg/L,高于对照组的（37.31±1.32）g/L、（1.89±0.37）g/L、（234.74±21.50）mg/L,差异有统计学意义（t=6.524、7.224、5.855,均P<0.001）;观察组干预后APACHEⅡ评分（6.10±0.47）分,低于对照组的（7.12±0.66）分,差异有统计学意义（t=7.792,P<0.001）;观察组机械通气时间、住院时间分别为（6.39±1.90）d、（8.12±1.64）d,短于对照组的（8.7...     

不同肠内营养输注方式对AECOPD无创通气治疗病人氧疗效果的影响

目的:比较三种不同肠内营养(EN)输注方式对慢性阻塞性肺疾病急性发作期(AECOPD)无创通气病人氧疗效果产生的影响。方法:采用前瞻性对照研究方法,将96例AECOPD行无创通气治疗病人按入院顺序依次分为连续喂养组、间歇连续喂养组和定时灌注组,每组各32例。比较三组病人EN治疗后第3、5、7天动脉血p H值、PaO_2(氧分压)、PaCO_2(二氧化碳分压)、PaO_2/FiO_2(氧合指数)等指标,同时对比三组病人日均费用、入住ICU天数、机械通气天数等综合指标。结果:连续喂养组和间歇连续喂养组治疗后第7天的p H值、入住ICU时间、机械通气时间均优于定时灌注组(P0.05)。连续喂养组病人的营养支持费用明显低于间歇连续喂养组(P0.05)。结论:两种连续喂养方式均能有效改善无创通气的AECOPD病人缺氧状况,降低病人入住ICU天数,缩短机械通气时间,降低费用。