CAJ | 학술논문

目的：探讨内镜辅助下空肠营养管置入术在老年危重症患者中的应用效果。方法选择2009年1月-2012年8月武汉市中心医院ICU收治的老年危重症患者100例，采用随机数字表法分为肠内营养（ EN）组和胃肠外营养（ PN）组，每组50例。PN组患者采用静脉营养；EN组患者行内镜辅助下空肠营养管置入术进行肠内营养。观察两组患者治疗前及治疗后第7、14天血红蛋白，血清清蛋白，前清蛋白及CRP水平，体质量，氮平衡，急性生理与慢性健康评分系统Ⅱ（ APACHEⅡ）评分，并发症情况。结果治疗前两组患者观察指标比较，差异均无统计学意义（ P>0.05）。治疗后第7天EN组患者前清蛋白水平高于PN组（P<0.05）；治疗后第14天EN组患者血红蛋白、血清清蛋白及前清蛋白水平高于PN组（P<0.05）。治疗后第7、14天EN组患者体质量、氮平衡均高于PN组，血清CRP水平低于PN组（P<0.05）。治疗后第14天EN组患者APACHEⅡ评分低于PN组（P<0.05）。PN组有6例（12%）患者发生静脉炎；EN组在治疗前期有4例（8%）患者出现腹胀，3例（6%）患者出现腹泻，经调整输入速度、浓度及温度后均自行好转。结论老年危重症患者行内镜辅助下空肠营养管置入术进行肠内营养安全有效，有助于改善患者营养状况，提高患者免疫力，促进患者康复。
목적：탐토내경보조하공장영양관치입술재노년위중증환자중적응용효과。방법선택2009년1월-2012년8월무한시중심의원ICU수치적노년위중증환자100례，채용수궤수자표법분위장내영양（ EN）조화위장외영양（ PN）조，매조50례。PN조환자채용정맥영양；EN조환자행내경보조하공장영양관치입술진행장내영양。관찰량조환자치료전급치료후제7、14천혈홍단백，혈청청단백，전청단백급CRP수평，체질량，담평형，급성생리여만성건강평분계통Ⅱ（ APACHEⅡ）평분，병발증정황。결과치료전량조환자관찰지표비교，차이균무통계학의의（ P>0.05）。치료후제7천EN조환자전청단백수평고우PN조（P<0.05）；치료후제14천EN조환자혈홍단백、혈청청단백급전청단백수평고우PN조（P<0.05）。치료후제7、14천EN조환자체질량、담평형균고우PN조，혈청CRP수평저우PN조（P<0.05）。치료후제14천EN조환자APACHEⅡ평분저우PN조（P<0.05）。PN조유6례（12%）환자발생정맥염；EN조재치료전기유4례（8%）환자출현복창，3례（6%）환자출현복사，경조정수입속도、농도급온도후균자행호전。결론노년위중증환자행내경보조하공장영양관치입술진행장내영양안전유효，유조우개선환자영양상황，제고환자면역력，촉진환자강복。
Objective To explore the application effects of endoscopic nasojejunal feeding tube placement in elderly critically ill patients. Methods From January 2009 to August 2012,100 elderly critically ill patients admitted to ICU of this hospital were divided randomly into groups EN,PN,50 in each. PN group were given intravenous nutrition,EN group under-went endoscopic nasojejunal feeding tube placement for enteral nutrition. Hemoglobin,serum albumin,prealbumin and CRP levels,weight,nitrogen balance,acute physiology and chronic health evaluation systemⅡ( APACHEⅡ) scores,complica-tions were observed before treatment and on days 7,14 after treatment. ResUlts There was no significant difference in the above mentioned indicators between 2 groups before treatment(P>0. 05). The prealbumin level was higher in EN group than in PN group on days 7 after treatment(P<0. 05),and hemoglobin,serum albumin,prealbumin higher on days 14 after treatment (P<0. 05). Body weight,nitrogen balance were higher,serum CRP lower in EN group than in PN group on days 7,14 after treatment(P<0. 05). APACHEⅡ scores were lower in EN group than in PN group on days 14 after treatment(P<0. 05). Six patients had phlebitis in PN group(12%),4 had abdominal distension and 3 had diarrhea in EN group(8%,6%,re-spectively) at the beginning of treatment. After adjusted input velocity concentration and temperature are spontaneously. Con-clUsion Endoscopic nasojejunal feeding tube placement,safe and effective,helps improve nutritional status and immunity in elderly critically ill patients.