机械通气患者早期肠内营养与胃黏膜pH值监测的临床应用

目的 观察早期肠内营养及胃黏膜pH值(pHi)监测对重症监护病房(ICU)中非胃肠道外伤或手术需机械通气患者的疗效.方法 通过连续监测40例患者术后7 d内pHi的变化,并根据生命体征和肠鸣音的恢复情况分别于术后12～72 h内(早期)给予肠内营养(25例)和静脉营养(15例),比较两组7 d内脱机成功率及机械通气时间.结果 肠内营养组7 d内脱机成功率明显高于静脉营养组76%(19/25)比40%(6/15),P<0.05],机械通气时间则明显短于静脉营养组(4.30±0.01)d比(8.22±0.02)d,P<0.05];肠内营养组术后7 d pHi较1 d时增加(7.39±0.03比7.28±0.01,P<0.05),且明显高于静脉营养组(7.30±0.02,P<0.05).此外,肠内营养组较静脉营养组恢复排气时间明显缩短(47.08±8.33)h比(67.03±8.03)h,P<0.05].结论 pHi监测是反映危重病患者胃肠黏膜血液灌注及氧合状态的敏感指标;早期实施肠内营养可以改善患者胃肠黏膜血液灌注,从而有效防止肠道细菌移位的发生,提高脱机成功率并缩短时间;只要胃肠道功能正常,应尽早实施肠内营养支持.

Early enteral nutrition and gastric intramucosal pH monitoring in patients with mechanical ventilation

Objective To observe the effect of early enteral nutrition and the significance of gastric intramucosal pH (pHi) monitoring in patients without gastrointestinal trauma or surgery requiring mechanical ventilation in the intensive care unit (ICU). Methods Depending mainly on the vital signs and recovery of intestinal peristalsis sounds, enteral nutrition (25 cases) and parenteral nutrition (15 cases) were respectively given to the 40 patients requring mechanical ventilation 12-72 hours (early) after operation. The value of gastric pHi was monitored continuously for the following 7 days. In addition, success rate of weaning, and mechanical ventilation duration were compared between the two groups. Results After 7 days, the success rate of weaning in enteral nutrition group was significantly higher than that in parenteral nutrition group 76% (19/25) vs. 40% (6/15), P<0.05]. The mechanical ventilation duration in enteral nutrition group was obviously lower than that in parenteral nutrition group (4.30±0.01) days vs. (8.22±0.02) days, P<0.05]. The value of gastric pHi increased in enteral nutrition group on the 7th day (7.39±0.03 vs. 7.28±0.01, P<0.05), and the value was higher than that of the parenteral nutrition group (7.30±0.02, P<0.05). In addition, the restoration of passage of flatus in enteral nutrition group was significantly earlier than that of parenteral nutrition group (47.08±8.33) hours vs. (67.03±8.03) hours, P<0.05). Conclusion Early enteral nutrition can improve the blood perfusion and oxygenation of gastrointestinal mucosa, and the success rate of weaning of mechanical ventilation, help reduce complications, and shorten the mechanical ventilation duration. Enteral nutrition support should be given to ICU patients with mechanical ventilation as early as possible provided that the enteral function is normal.