外科重症患者血液净化联合早期肠内营养的效果

目的：探讨外科重症患者血液净化联合早期肠内营养治疗对加速康复的影响。方法选择入住ICU的重症患者239例,将2011年6月-2012年5月收治的118例患者作为对照组,2012年6月-2013年5月收治的121例患者作为观察组,对照组患者在生命体征平稳、肠道功能开始恢复后实施肠内营养,出现急性肾损伤时开始床边CBP治疗;观察组患者在入住ICU的24～48 h内开始早期肠内营养,同时常规CBP治疗;比较两组治疗效果。结果观察组CBP治疗前血清白蛋白（34．33±4．85） g/L,治疗1周后提高至（39．72±4．72）g/L,差异有统计学意义（t ＝-9．219,P ＜0．01）;对照组治疗前（34．86±4．70）g/L,治疗后（34．04±4．62）g/L,差异无统计学意义（t＝1．957,P＞0．05）;两组血清白蛋白治疗后组间比较,差异有统计学意义（t＝-9．397,P＜0．01）。观察组住ICU时间（17．68±2．96）d,机械通气时间（8．49±2．35）d,CBP治疗时间（78．13±12．72）h,均低于对照组的（18．83±3．46）d,（9．48±2．86）d,（126．50±19．56）h,差异有统计学意义（t值分别为2．768,2．163,22．602;P＜0．05）。结论重症患者血液净化同时开始早期肠内营养治疗,可有效改善营养指标,减少白蛋白的丢失,缩短了机械通气和住ICU时间,加速了外科重症患者的康复。

Effect of the blood purification combined with early enteral nutrition in critical patients in surgery

Objective To explore the effect of the blood purification combined with early enteral nutrition on the accelerating rehabilitation in critical patients in surgery .Methods Two hundred and thirty-nine critical patients in ICU were chosen , and the patients from June 2011 to May 2012 were divided into the control group （ n=118 ） , and from June 2012 to May 2013 were divided into the observation group （ n=121 ） .The control group received the enteral nutrition after the recovery of intestinal function , and bedside continuous blood purification （ CBP） on the occurrence of acute kidney injury .The observation group received the early enteral nutrition and the routine CBP 24-48 h after the ICU .The therapeutic effect was compared between two groups . Results The level of albumin in the observation group was （34.33 ±4.85）g/L before the treatment, and was （39.72 ±4.72）g/L after the treatment, and the difference was statistically significant （t =-9.219,P 0.05）.The difference was found in the level of albumin after the treatment between two groups （t=-9.397, P〈0.01）.The times of hospitalization in ICU, mechanical ventilation and the CBP treatment in the observation group were respectively （17.68 ±2.96） d, （8.49 ±2.35） d, （78.13 ±12.72） h, and were lower than （18.83 ±3.46）d, （9.48 ±2.86） d, （126.50 ±19.56） h in the control group, and the differences were statistically significant （t=2.768, 2.163, 22.602, respectively;P〈0.05）.Conclusions Application of the blood purification combined with early enteral nutrition in the critical patients in surgery can effectively improve their nutritional index , and reduce the loss of albumin , and shorten the times of mechanical ventilation and hospitalization in ICU , and accelerate the rehabilitation .