机械通气患者早期肠内营养支持的应用研究

目的:探讨早期肠内营养对机械通气患者营养状态和预后的影响.方法:机械通气患者30例,随机分为2组:早期肠内营养(EEN)组15例和早期完全胃肠外营养(TPN)组15例,在摄入相当热量和氮量的情况下,比较2组治疗前后营养状态、1周内撤机成功率、呼吸机相关性肺炎(VAP)发生率、平均营养费用、机械通气时间及平均住院天数.结果:治疗2周后,EEN组血清总蛋白、清蛋白、血红蛋白水平和氮平衡较治疗前明显升高(均P＜0.05),且均高于TPN组治疗后水平(均P＜0.05).上臂肌围、肱三头肌皮褶厚度2组无差异(P＞0.05).EEN组1周内撤机成功率明显高于TPN组(P＜0.05),机械通气时间、平均住院天数则明显低于TPN组(均P＜0.05).2组1周内VAP发生率差异无统计学意义(P＞0.05).结论:EEN能改善机械通气患者的营养状况和预后.只要患者胃肠道功能正常,应尽早实施肠内营养支持.

Study on application of early enteral nutrition support in patients with mechanical ventilation

Objective: To investigate the effects of early enteral nutrition on nutritional status and prognosis of patients with mechanical ventilation. Methods: Thirty cases with mechanical ventilation were randomly divided into two groups: 15 cases with early enteral nutrition ( EEN ) group and 15 cases with early total parenteral nutrition ( TPN ) group. The nutritional state, one week extubation success rate, incidence of ventilator-associated pneumonia ( VAP ), average cost of nutrition, the duration of mechanical ventilation and the average length of hospital stay were compared between two groups before and after treatment with a similar caloric and nitrogen content. Results: The serum total protein, albumin, hemoglobin levels and nitrogen balance were significantly elevated after treatment for 2 weeks than before treatment in EEN group (P < 0.05), and were higher than those in TPN group after treatment (P < 0.05 ) . The upper arm muscle circumference, triceps skinfold thickness between the two groups had no difference (P > 0.05 ). One week extubation success rate was significantly higher in EEN than that in TPN group ( P < 0.05 ), the duration of mechanical ventilation and the average length of hospital stay were significantly less than those in TPN group (P < 0.05 ). There was no statistical difference in incidence of VAP within one week between two groups (P > 0.05 ). Conclusions: EEN can improve the nutritional status and prognosis of patients with mechanical ventilation. Enteral nutrition should be carried out as early as possible if patients’ gastrointestinal function is normal.