不同肠内营养途径对危重症患者的临床意义

目的比较不同肠内营养途径在危重症患者营养治疗中的安全性及不良反应。方法前瞻性研究2009年1月1日至2011年1月1日江西省人民医院重症医学科行肠内营养(EN)的患者,根据肠内营养途径不同分为NGT组和PEG组,NGT组为留置鼻胃管患者,PEG组为经皮内镜下胃造瘘患者,检测治疗前后2、3和4周白蛋白(ALB)、前白蛋白(PA)水平,统计两组患者医院获得性鼻窦炎发病率和住院期间医院获得性肺炎患病率,记录患者ICU住院时间和总住院时间。结果共有52例患者入选,两组患者治疗后第2周ALB和PA明显高于治疗前,治疗至第4周接近正常。PEG组未见医院获得性鼻窦炎发生,医院获得性肺炎的患病率明显低于NGT组患者(20%对40.6%P﹤0.05);PEG组患者ICU住院时间为(14±2.7)d,总住院时间为(23±4.2)d,与NGT组患者ICU住院时间(21±1.8)d和总住院时间(25±2.9)d相比,ICU住院时间明显缩短(P<0.05),总住院时间无明显统计学差异(P﹥0.05)。结论 EN可改善危重症患者的营养不良,PEG对需行肠内营养的ICU患者是一种更安全有效的输注途径,能明显降低不良反应发生率,缩短患者ICU入住时间,降低医疗花费。

The comparison of different enteral nutrition approaches in ICU patients

Objective To compare the safety and adverse reaction in different enteral intestinal nutrition approaches of nutrition treatment on patients in intensive care unit.Method From January 1st 2009 to January 1st 2011,EN patients in ICU were recruited in this prospective study.Moreover,the patients can be divided into NGT group and PEG group in this study,which NGT group were replaced nasogastric tube patients and PEG were percutaneous endoscopic gastrotomy patients.ALB and PA levels were detected after 2,3 or 4 weeks treatment.And the morbidity of nosocomial sinusitis and nosocomial pneumonia,the duration of patients stay at ICU and hospital also were recorded.Results 52 patients were involved the study.The ALB and PA of two group patients was clearly higher in the second week after treatment,the fourth week to normal.The PEG group didn＇t occur the morbidity of nosocomial sinusitis.And the morbidity of nosocomial pneumonia was significant lower in NGT group（20% VS 40.6% P﹤0.05）;In PEG group the length of patients was 14± 2.7 days in ICU,and 23±4.2 days in hospital.In NGT group the duration were 21±1.8 days and 25±2.9 days.The duration in ICU was obviously shorter in PEG group than in NGT group（P0.05）,there was no significant difference in duration in hospital（P﹥0.05）.Conclusion EN can improve the cacotrophy of patients in intensive care unit.PEG is a more safe and effective way to ICU patients required EN,which lower the incedence rate of adverse reaction obviously,shorten the time in ICU and reduce the medical expenses.