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.

Effect of different enteral nutrition approaches on ventilator-associated pneumonia

OBJECTIVE To evaluate the effect of different nutrition approaches on the nutritional status,enteral tolerance and incidence of ventilator-associated pneumonia of the patients with mechanical ventilation.METHODS A total of 64 patients with mechanical ventilation were randomized into 2 groups: naso-gastric tube group and naso-postpyloric tube group,with 32 cases in each;both groups received enteral formulations,the shortage part was supplemented by the parenteral nutrition;the change of nutrition indicators before and after the treatment was observed,the nutritional status,complications and tolerance of enteral nutrition,the incidence of ventilator-associated pneumonia,and the duration of mechanical ventilation and ICU stay were compared.RESULTS The prealbumin of the naso-gastric tube group before and after the treatment were(161.8±19.1)mg/L,and(193.7±27.0)mg/L,the naso-postpyloric tube group(182.5±29.4)mg/L and(214.32.4)mg/L;the transferrin of the naso-gastric tube group before and after the treatment were(228.3±42.1)mg/L and(266.3±23.1)mg/L,the naso-postpyloric tube group(223.1±26.2) and(272.6±25.5),the differences were statistically significant(P<0.05);the incidence rates of abdominal distension and diarrhea of the naso-gastric group and the naso-postpyloric group were 25.0% and 15.6%,high blood sugar 28.1% and 6.2%,stress ulcer 6.2% and 3.1%,liver damage 6.2% and 3.1%,the differences were not statistically significant;the incidence rates of both reflux and ventilator-associated pneumonia of the naso-postpyloric tube group were 6.2%,lower than 31.2% and 18.7% of the naso-gastric tube group(P<0.05);the ventilation duration and the ICU stay were shorter in naso-postpyloric tube group(6.5±1.1)d and(8.9±1.8) d than naso-gastric tube group(9.8±2.3)d and(13.4±2.4)d(P<0.01).CONCLUSION Enteral nutrition can improve the nutritional status of patients with mechanicalventilation;the enteral nutrition through naso-postpyloric tube has a better intestinal tolerance and is with lower incidence of ventilator-associated pneumonia.