肠内联合肠外营养的应用对危重症患者的预后影响

目的:研究肠内联合肠外营养(EN+PN)支持在危重症病人中的临床应用效果. 方法:将60例有部分或全部胃肠功能的危重症病例随机分为肠内联合肠外营养(EN+PN)支持组、完全肠内营养(TEN)支持组和完全肠外营养(TPN)支持组,每组20例,对比观察营养支持前1d及营养支持后d7患者的体重指数、肱三头肌皮褶厚度、血清前白蛋白、白蛋白、总蛋白、血红蛋白、免疫球蛋白、淋巴细胞计数,且每天观察并发症情况. 结果:营养指标比较:经EN+PN支持后,血清前白蛋白明显升高(P<0.01),总蛋白、白蛋白、血红蛋白、免疫球蛋白、淋巴细胞计数亦有升高(P<0.05);而TEN和TPN支持后,各指标结果无显著差异.三组对比,EN+PN支持组血清前白蛋白、白蛋白、总蛋白、血红蛋白、免疫球蛋白、淋巴细胞计数均高于EN组和PN组(P<0.05),体重指数,肱三头肌皮褶厚度无显著差异.并发症比较:EN+PN支持组患者并发症的发生率显著低于EN组和PN组(P<0.05).结论:EN+PN支持更符合生理状态,有更好的代谢效应,能改善危重症病例营养状况提高免疫功能,降低并发症发生率,对有部分或全部胃肠功能的危重症病例,应尽量早期采用.

The influence of application on enteral combined with parenteral nutrition in prognosis of critically ill patients

Objective:To study the clinical application effect of enteral combined with parenteral nutrition support on critically ill patients. Methods: Nutrition support were analyzed in 60 critically ill patients, with 20 cases supported by enteral combined with parenteral nutrition,20 cases supported by enteral nutrition and 20 cases supported by parenteral nutrition.compared with body mass index(BMI), the thickness of triceps skin fold(TSF),serum prealbumin,albumin,total protein,hemoglobin,immunoglobulin,lymphocyte count between the day before nutritional support and the seventh day after nutritional support,and the situation of related complications were observed. Results:comparasion of nutrient parameter:It was found that serum prealbumin improved obviously (P<0.01) and albumin,total protein, hemoglobin,immunoglobulin,lymphocyte count were elevated (P<0.05) in patients with EN+PN.There was no differences in BMI and TSF. comparison of the complications:The complication rate of enteral combined with parenteral nutrition support patients is obviously lower than EN group,PN group Conclusions: Enteral combined with Parenteral nutrition support accord with physiological state and has better metabolic effect,and improve the nutritional status and immune function,reduce complication rate,In critically ill patients,enteral combined with parenteral nutrition support should be selected.