机械通气的呼吸衰竭患者肠内营养的临床应用

目的 比较呼吸衰竭需要机械通气的患者肠内与肠外营养的效果与优缺点.方法 选择呼吸监护室的呼吸衰竭行机械通气患者62例,随机分为肠内营养组(治疗组)与肠外营养组(对照组).治疗组给予瑞高,对照组给予一般静脉营养支持治疗.对比两组血气、营养指标变化、撤机、住ICU与营养支持时间和并发症发生情况.结果 除住ICU时间治疗组短于对照组(P＜0.05)外,其余指标两组无显著性差异.肠外营养支持的静脉血栓发生率为30%,局部出血、诱发/加重心力衰竭、气胸/血气胸、呼吸机相关肺炎发生率分别为27%、20%、17%、10%;肠内营养支持出现腹胀、恶心、呼吸机相关肺炎、脱管、误吸各占31%、22%、19%、15.6%、12.5%.结论 呼吸衰竭的机械通气患者肠内与肠外营养一样可取得较好疗效,但肠内营养方便,并发症较轻,可缩短住ICU时间,更适合心功能不全的患者,是花费低、效果好的营养支持途径.

Clinical application of enteral nutrition support in patients with respiratory failure with mechanical ventilation

Objective To compare the effectiveness, advantages and complications of enteral and parenteral nutritions in patients with respiratory failure who were treated with mechanical ventilation. Methods Sixty-two patients with respiratory failure admitted to the respiratory intensive care unit and who needed mechanical ventilation were randomized into two groups: the intestinal group(study group, n=32) in which patients got nutrition support via nusogastric tube received Fresubin 750 MCT and the parenteral nutrition group(control group,n=30) who were supported by venous nutrition after endotracheal intubation and initiation of mechanical ventilation. The arterial blood gas nutritional parameter,duration of mechanical ventilation and length of stay at ICU and approaches nutrition support,complication of nutrition support were analyzed. Results The duration of ICU stay was shorter in the study group than that in the control group(P<0.05). The arterial blood gas analysis and other nutritional parameters, duration of mechanical ventilation and nutrition support had no significant difference between the two groups. In the study group, the incidence of abdominal distension was 31%, nausea in 22%, ventilator-associated pneumonia in 19%, dislocation of nasogastric(intestinal) tube and aspiration in 15.6% and 12.5% respectively. In the control group, the incidence of venous thrombosis was 30%, local bleeding,induced and/or exacerbated heart failure, while pneumothorax or pneumohemothorax,ventilator-associated pneumonia occurred in 27%, 20%, 17%, 10% individually. Conclusions Enteral nutrition is as effective as parenteral nutrition in mechanically ventilated patients and it is rational, free of serious complication and can short the duration of stay at ICU. It is appropriate for patients with heart dysfunction and can reduce the medical-care costs.