CAJ | 학술논문

目的评估临床营养支持模式与实施方法对成年急性重症患者近期临床结局的影响.方法回顾性分析1994年1月至2009年12月在海南省人民医院重症医学科收治的1503例成年急性重症患者的营养支持相关资料,比较不同营养支持模式与实施方法对营养支持并发症、患者在ICU停留时间、感染与多器官功能障碍综合征(MODS)发生率和病死率的影响.结果所有患者营养风险筛查评分(NRS)均≥3分.早期肠内营养(EN)组患者在ICU的停留时间明显短于非早期EN组(P＜0.001)和肠外营养(PN)组(P＜0.001),感染发生率(P均＜0.001)、MODS发生率(P均＜0.001)及病死率(P均＜0.001)也均明显低于非早期EN组和PN组患者.PN液中添加谷氨酰胺组患者在ICU停留时间明显短于未添加者(P=0.0000),感染(P=0.0252)和MODS发生率(P=0.0030)及病死率(P=0.0305)均明显低于未添加者.强化胰岛素治疗组患者在ICU停留时间明显短于常规胰岛素治疗组(P=0.0000),感染(P=0.0001)和MODS发生率(P=0.0237)及病死率(P=0.0427)均明显低于常规胰岛素治疗组.结论重症患者普遍存在营养风险,需要给予营养支持.早期EN、PN液中添加谷氨酰胺及给予强化胰岛素治疗能够缩短患者在ICU停留的时间,降低感染和MODS发生率及病死率.
목적 평고림상영양지지모식여실시방법대성년급성중증환자근기림상결국적영향.방법 회고성분석1994년1월지2009년12월재해남성인민의원중증의학과수치적1503례성년급성중증환자적영양지지상관자료,비교불동영양지지모식여실시방법대영양지지병발증、환자재ICU정류시간、감염여다기관공능장애종합정(MODS)발생솔화병사솔적영향.결과 소유환자영양풍험사사평분(NRS)균≥3분.조기장내영양(EN)조환자재ICU적정류시간명현단우비조기EN조(P＜0.001)화장외영양(PN)조(P＜0.001),감염발생솔(P균＜0.001)、MODS발생솔(P균＜0.001)급병사솔(P균＜0.001)야균명현저우비조기EN조화PN조환자.PN액중첨가곡안선알조환자재ICU정류시간명현단우미첨가자(P=0.0000),감염(P=0.0252)화MODS발생솔(P=0.0030)급병사솔(P=0.0305)균명현저우미첨가자.강화이도소치료조환자재ICU정류시간명현단우상규이도소치료조(P=0.0000),감염(P=0.0001)화MODS발생솔(P=0.0237)급병사솔(P=0.0427)균명현저우상규이도소치료조.결론 중증환자보편존재영양풍험,수요급여영양지지.조기EN、PN액중첨가곡안선알급급여강화이도소치료능구축단환자재ICU정류적시간,강저감염화MODS발생솔급병사솔.
Objective To explore the impacts of different nutrition support methods on short-term outcome in critically ill adult patients. Methods We retrospectively reviewed the clinical data of 1503 critically ill adult patients who needed nutrition support in an mixed intensive care unit (ICU) of a tertiary care university hospital from January 1994 to December 2009. The complication of nutrition support, length of stay (LOS) in ICU, morbidity of infection and multiple organ dysfunction syndrome (MODS), and mortality among different nutrition support methods were compared. Results The Nutritional Risk Screening (NRS) scores of the enrolled patients were no less than 3. LOS in early enteral nutrition (EN) patients were significantly shorter than those in not-early EN patients (P ＜ 0. 001) and parenteral nutrition (PN) patients (both P ＜ 0. 001). Infection rate (P ＜ 0. 001),morbidity of MODS (P ＜ 0. 001) and mortality (P ＜ 0. 001) were significantly lower than those in not-early EN and PN patients. LOS of patients receiving PN rich in glutamine (Gln) was significantly shorter than that in conventional formula (P = 0. 0000). Morbidity of infection (P= 0. 0252) and MODS (P = 0. 0030), mortality (P =0. 0305) were significantly lower than that of conventional patients. LOS of patients receiving intensive insulin therapy (IIT) was significantly shorter than that of controlled group (P = 0. 0000). Morbidity of infection (P =0. 0001) and MODS (P = 0. 0237) and mortality (P =0. 0427) were significandy lower than those of controlled group. Conclusions Nutritional risk is prevalent among critically ill adult patients. Early EN, PN of rich in Gln,and receiving IIT can shorten LOS, decrease morbidity of infection and MODS, and improve prognosis among these patients.