CAJ | 학술논문

目的观察早期肠内营养(EEN)支持对ICU机械通气患者的辅助治疗作用.方法机械通气时间大于1周的患者47例,随机分为EEN组(n=24)和对照组(n=23).EEN组入住ICU后12 ～24 h给予肠内营养(EN),对照组入住ICU后72h～5 d给予EN,利用双糖试验法(乳果糖/甘露醇,L/M)测定两组患者肠黏膜屏障功能,观察患者体质量指数、体温、L/M比值、血清白蛋白、前白蛋白、脱机时间等临床指标.结果入住ICU第7天时EEN组L/M为0.036±0.004,而对照组为0.108±0.020,EEN组明显低于对照组(t=2.746,P＜0.01).EEN组平均体温(38.25±1.20)℃,低于对照组(38.92±1.40)℃(t=2.683,P＜0.05)便秘腹泻不良反应发生率[16.7％(4/23)与27.3％ (6/22)]及2周脱机成功率[90％ (18/20)与80％ (16/20)]好于对照组(x2值分别为5.36、6.08,均P＜0.05)；营养状态血清白蛋白、前白蛋白水平也较对照组有增高趋势.结论早期应用肠内营养支持对呼吸机辅助通气患者能改善肠黏膜屏障,提高脱机成功率.
목적 관찰조기장내영양(EEN)지지대ICU궤계통기환자적보조치료작용.방법 궤계통기시간대우1주적환자47례,수궤분위EEN조(n=24)화대조조(n=23).EEN조입주ICU후12 ～24 h급여장내영양(EN),대조조입주ICU후72h～5 d급여EN,이용쌍당시험법(유과당/감로순,L/M)측정량조환자장점막병장공능,관찰환자체질량지수、체온、L/M비치、혈청백단백、전백단백、탈궤시간등림상지표.결과 입주ICU제7천시EEN조L/M위0.036±0.004,이대조조위0.108±0.020,EEN조명현저우대조조(t=2.746,P＜0.01).EEN조평균체온(38.25±1.20)℃,저우대조조(38.92±1.40)℃(t=2.683,P＜0.05)편비복사불량반응발생솔[16.7％(4/23)여27.3％ (6/22)]급2주탈궤성공솔[90％ (18/20)여80％ (16/20)]호우대조조(x2치분별위5.36、6.08,균P＜0.05)；영양상태혈청백단백、전백단백수평야교대조조유증고추세.결론 조기응용장내영양지지대호흡궤보조통기환자능개선장점막병장,제고탈궤성공솔.
Objective To observe the effectiveness of early enteral nutrition (EEN) in managing ICU mechanically ventilated patients.Methods Totally 47 patients who had been ventilated for more than one week were randomly divided into EEN group and control group.The EEN group was supplied with enteral nutrition (EN) 12-24 hours after ICU admission,whereas the control group received EN 72 hours-5 days later.The function of intestinal mucosal barrier was evaluated by the reabsorb concentration of disaccharides lactulose/mannitol (L/M).In addition,the body mass index (BMI),body temperature,urine L/M ratio,serum albumin,pre-albumin,and ventilation days were recorded or calculated.Results On the seventh day,the L/M ratio was (0.036 ±0.004) in the EEN group,which was significantly lower than that (0.108 ±0.020) in the control group (t =2.746,P ＜0.01) ; the average body temperature was significantly lower in the EEN group than in the control group [(38.25 ± 1.20) ℃ vs (38.92 ± 1.40) ℃ ; t =2.683,P ＜ 0.05)] ; the incidences of adverse reactions such as constipation and diarrhea were significantly lower in the EEN group [16.7％ (4/23) vs 27.3％ (6/22),P＜0.05].The weaning rate within 2 weeks also favoured the EEN group [90％ (18/20) vs 80％ (16/20),P ＜ 0.05].Compared with the control group,the nutritional status of serum albumin and pre-albumin also showed a favourbale trends in the EEN group.Conclusions EEN can improve intestinal mucosal barrier and increase the weaning possibility in patients with mechanical ventilation.