早期不同营养支持方式在机械通气重症患者中的应用

目的探讨早期3种营养支持方式对机械通气重症患者疗效及预后的影响，为临床提供参考。方法选择2009年2月至2011年12月由各种病因所致的行机械通气治疗的重症住院患者90例，按随机数字法随机分为3组，每组各30例，分别予以肠外营养（PN）、肠内营养（EN）、肠内外联合营养（CEPN）支持。检测机械通气第1天、第7天所有患者的营养指标（氮平衡、白蛋白）、免疫指标（IgA、IgG）及血浆内毒素水平，并观察早期并发症发生及治疗情况。结果90例患者早期成功脱离呼吸机57例，死亡25例，出现并发症32例。在机械通气第7天，CEPN组及EN组各项观察指标（氮平衡、自蛋白、IgA、IgG、内毒素水平、并发症例数、脱机数）均优于PN组。PN组：（2．3±1．2）g／d，（30．6±2．7），（1．4±0．5），（7．8±2．1）g／L，（37．1±6．3）Pg／ml，17例，13例；EN组：（4．2±0．5）g／d，（33．5±1．8），（2．5±0．3），（13．6±1．5）g／L，（49．7±7．3）pg／ml，9例，21例；CEPN组：（5．8±0．8）g／d，（35．8±1．7），（2．5±0．2），（13．9±1．7）g／L，（50．3±7．1）pg／ml，6例，23例，差异具有统计学意义（EN组与PN组比较t值分别为－5.158，－2．308，－7．113，－5．031，-2．259；x^2值分别为4．800，6．533；p均〈0．05；CEPN组与PN组比较t值分别为－8．473，－4．201，－6．570，-5．852，-3．141；X^2值分别为9．966，12．448；P均〈0．05）；CEPN组与EN组在营养指标、并发症发生率上的差异具有统计学意义（t值分别为-4．765，-1．169；x^2=4．172；P均〈0．05）。结论对于机械通气的重症患者，早期在尽可能实施EN的基础上，联合适当的PN是一种更为合理有效的营养支持方式，可有效提高患者的综合疗效，减少并发症的发生。

Application of different nutritional support modes in early stage for severe mechanical ventilation patients

Objective To explore three nutritional support mode in early stage on curative effect and outcome in the severe patients with mechanical ventilation and provide references for the clinic. Methods A total of 90 patients with mechanical ventilation from February 2009 to December 2011 were randomly divided into group A, B and C with 30 cases in every group, and were recevied parenteral nutrition（PN）, enteral nutrition（EN） and combined enteral and parenteral nutrition（ CEPN）, respectively. The nutrition indexes, the immune indexes and the level of plasma endotoxin were mensurated in the 1st day and the 7th day after mechanical ventilation. The complications and the condition changes were carefully observed. Results Among 90 cases, 57 cases were successfully detached from the respirator, at early stage, 25 cases died,32 cases had complications. All the observation indexes including nitrogen balance, albumin, IgA, IgG, the level of plasma endotoxi, the cases with complication, and the cases detached from respirator were recorded in the 7th day after mechanical ventilation, group A（PN）：（2.3 ± 1.2）g/d,（30.6 ±2.7）,（1.4 ±0.5）,（7.8 ±2.1） g/L, （37.1 ±6.3） pg/ml, 17 cases,13 cases; group B（EN） ：（4.2 ±0.5） g/d,（33.5 ±1.8） ,（2.5 ±0.3） ,（13.6±1.5） g/L,（49.7 ±7.3） pg/ml,9cases,21 cases, groupC（CEPN）：（5.8±0.8） g/d,（35.8±1.7）,（2.5 ± 0.2）,（13.9±1.7 ） g/L, （ 50.3 ±7.1 ） pg/ml,23 cases ,6 cases. The differences between all the observation indexes in group B and C were superior to group A ,which showed statistically significant difference（ P 〈 O. 05 ）. The difference of nutrition indexes and the incidence of complication was statistically significant between group C and group B （P 〈 O. 05 ）. Conclusions EN combined with PN is an reasonable and effective nutrition support mode for patients with mechanical ventilation. It can improve the curative effects, and reduce the incidence of complication.