CAJ | 학술논문

目的探讨早期3种营养支持方式对机械通气重症患者疗效及预后的影响,为临床提供参考.方法选择2009年2月至2011年12月由各种病因所致的行机械通气治疗的重症住院患者90例,按随机数字法随机分为3组,每组各30例,分别予以肠外营养(PN)、肠内营养(EN)、肠内外联合营养(CEPN)支持.检测机械通气第1天、第7天所有患者的营养指标(氮平衡、白蛋白)、免疫指标(IgA、IgG)及血浆内毒素水平,并观察早期并发症发生及治疗情况.结果 90例患者早期成功脱离呼吸机57例,死亡25例,出现并发症32例.在机械通气第7天,CEPN组及EN组各项观察指标(氮平衡、白蛋白、IgA、IgG、内毒素水平、并发症例数、脱机数)均优于PN组.PN组:(2.3±1.2)g/d,(30.6±2.7),(1.4±0.5),(7.8±2.1) g/L,(37.1±6.3) pg/ml,17例,13例；EN组:(4.2±0.5)g/d,(33.5±1.8),(2.5±0.3),(13.6±1.5) g/L,(49.7±7.3)Pg/ml,9例,21例；CEPN组:(5.8±0.8)g/d,(35.8±1.7),(2.5 ±0.2),(13.9±1.7)g/L,(50.3±7.1) pg/ml,6例,23例,差异具有统计学意义(EN组与PN组比较t值分别为-5.158,-2.308,-7.113,-5.031,-2.259;x2值分别为4.800,6.533；P均＜0.05;CEPN组与PN组比较t值分别为-8.473,-4.201,-6.570,-5.852,-3.141；x2值分别为9.966,12.448;P均＜0.05)；CEPN组与EN组在营养指标、并发症发生率上的差异具有统计学意义(t值分别为-4.765,-1.169；x2=4.172；P均＜0.05).结论对于机械通气的重症患者,早期在尽可能实施EN的基础上,联合适当的PN是一种更为合理有效的营养支持方式,可有效提高患者的综合疗效,减少并发症的发生.
목적 탐토조기3충영양지지방식대궤계통기중증환자료효급예후적영향,위림상제공삼고.방법 선택2009년2월지2011년12월유각충병인소치적행궤계통기치료적중증주원환자90례,안수궤수자법수궤분위3조,매조각30례,분별여이장외영양(PN)、장내영양(EN)、장내외연합영양(CEPN)지지.검측궤계통기제1천、제7천소유환자적영양지표(담평형、백단백)、면역지표(IgA、IgG)급혈장내독소수평,병관찰조기병발증발생급치료정황.결과 90례환자조기성공탈리호흡궤57례,사망25례,출현병발증32례.재궤계통기제7천,CEPN조급EN조각항관찰지표(담평형、백단백、IgA、IgG、내독소수평、병발증례수、탈궤수)균우우PN조.PN조:(2.3±1.2)g/d,(30.6±2.7),(1.4±0.5),(7.8±2.1) g/L,(37.1±6.3) pg/ml,17례,13례；EN조:(4.2±0.5)g/d,(33.5±1.8),(2.5±0.3),(13.6±1.5) g/L,(49.7±7.3)Pg/ml,9례,21례；CEPN조:(5.8±0.8)g/d,(35.8±1.7),(2.5 ±0.2),(13.9±1.7)g/L,(50.3±7.1) pg/ml,6례,23례,차이구유통계학의의(EN조여PN조비교t치분별위-5.158,-2.308,-7.113,-5.031,-2.259;x2치분별위4.800,6.533；P균＜0.05;CEPN조여PN조비교t치분별위-8.473,-4.201,-6.570,-5.852,-3.141；x2치분별위9.966,12.448;P균＜0.05)；CEPN조여EN조재영양지표、병발증발생솔상적차이구유통계학의의(t치분별위-4.765,-1.169；x2=4.172；P균＜0.05).결론 대우궤계통기적중증환자,조기재진가능실시EN적기출상,연합괄당적PN시일충경위합리유효적영양지지방식,가유효제고환자적종합료효,감소병발증적발생.
Objective To explore three nutritional support mode in early stage on curative effect and outcome in the severe patients with mechanical ventilation and provide references for the clinic.Methods A total of 90 patients with mechanical ventilation from February 2009 to December 2011 were randomly divided into group A,B and C with 30 cases in every group,and were recevied parenteral nutrition(PN),enteral nutrition(EN)and combined enteral and parenteral nutrition(CEPN),respectively.The nutrition indexes,the immune indexes and the level of plasma endotoxin were mensurated in the 1st day and the 7th day after mechanical ventilation.The complications and the condition changes were carefully observed.Results Among 90 cases,57 cases were successfully detached from the respirator,at early stage,25 cases died,32 cases had complicatinns.All the observation indexes including nitrogen balance,albumin,IgA,IgG,the level of plasma endotoxi,the cases with complication,and the cases detached from respirator were recorded in the 7th day after mechanical ventilation,group A(PN):(2.3±1.2)g/d,(30.6±2.7),(1.4±0.5),(7.8±2.1) g/L,(37.1 ±6.3) pg/ml,17 cases,13 cases; group B(EN):(4.2 ±0.5) g/d,(33.5 ±1.8),(2.5 ±0.3),(13.6 ±1.5) g/L,(49.7 ±7.3) pg/ml,9 cases,21 cases,group C(CEPN):(5.8 ±0.8) g/d,(35.8 ±1.7),(2.5 ± 0.2),(13.9±1.7) g/L,(50.3 ±7.1) pg/ml,23 cases,6 cases.The differences between all the observation indexes in group B and C were superior to group A,which showed statistically significant difference(P ＜0.05).The difference of nutrition indexes and the incidence of complication was statistically significant between group C and group B (P ＜ 0.05 ).Conclusions EN combined with PN is an reasonable and effective nutrition support mode for patients with mechanical ventilation. It can improve the curative effects,and reduce the incidence of complication.