营养支持对多器官功能不全综合征的治疗作用

目的为了观察营养支持对多器官功能不全综合征(MODS)治疗的临床作用。

The therapeutic effect of nutrition support in patients with multiple organ dysfunction syndrome (MODS)

Objective To estimate the clinical therapeutic effect of nutrition support in patients with Multiple Organ Dysfunction Syndrome (MODS). Methods We studied 4 patients (two male and two female )with MODS who received treatment in our hospital recently. The original pathology was abdominal cavity infection (50%), or the hemorrhagic pancreantitis (50%), half of patients had developed 4 main organ failures, the other two had 3 main organ failures. Besides the active treatment of the original disease, we used parenteral nutrition or enteral nutrition according to different phases of the disease. In early stage, the total parenteral nutrition is primary therapy, we adjusted the formula as the following: non-protein calorie was 30Kcal·kg-1·d-l, fat of which is about 40 %～50 %. The nitrogen is 0.25g·kg-1·d-1, To the patients who have renal failure we adjust the ratio of nitrogen versus calorie to 1g: 400Kcal and the nitrogen mainly comes from necessary amino acids. All the patients are given small accounts of oral glutamine and according to enteral function we change gradually parenteral nutrition to enteral nutrition. Results 3 patients were healed; one was died. The longest supporting days are 47d, the shortest was 23d. Discussion 1. We onghtto accept and understand correctly the conception of MODS, it reflects the reversible and ongoing characteristics of this syndrome and can guide us for early diagnosis and treatment. 2. The MODS is a dangerous syndrome that patients in the state of sever stress, catabolism, immune and other systems dysfunctions. The nutrition support can provide enough nutritious materials, rectify the negative balance of nitrogen, and create favorable conditions for rescuing the patients. 3. Severe stress may destroy the function of intestine mucosal harrier, and the translocation of bacteria and endotoxin will aggravate the illness. The administrations of glutamine and small amount of diet in early stage will prevent and obstruct the above course, the latter can also ameliorate the microcirculation of visceral blood vessels and quicken up the patient's recovery. 4. It's crucial to keep the balance of intern environment of the patients with MODS. We should restrict the percentage of glucose and heighten that of fat emulsion in patients with pulmonary failure, and it's better to use more branched amino acids except for those have renal failure, who should be given small amount of essentials amino acids. Conclusions The rational nutrition support can help the patients with MODS to survive the dangerous periods and improve their prognosis.