CAJ | 학술논문

将99例急性肺损伤患者按随机数字表法分为充分肠内营养组(充分EN组49例)与低剂量肠内营养组(低量EN组50例),观察治疗前和治疗7d后的前蛋白、转铁蛋白、氮平衡、7d与28d脱机成功率、28 d病死率和呼吸机相关肺炎发生率(VAP).观察两组患者治疗过程中呕吐发生率、胃潴留发生率、腹泻率、每天平均血糖值、每天胰岛素使用量、促胃肠动力药物使用频率(次数)及ICU住院时间(d)、营养费用、总住院费用.结果显示,治疗7d后,充分EN组较低量EN组7d和28 d脱机成功率(x2=0.417,P=0.81;x2=0.629,P =0.36) 、28 d临床VAP发生率(x2=0.235,P=0.16)、28 d病死率(x2=0.211,P=0.14)及ICU住院时问(=0.591,P=0.17)差异无统计学意义.呕吐发生率(x2=3.417,P=0.004)、胃潴留发生率(x2=3.592,P=0.003)、腹泻次数(x2=2.147,P=0.007)、腹胀发生率(x2 =3.915,P =0.001)、促胃肠动力药使用频率(x2=2.316,P=0.002)方面,两组差异有统计学意义.同时,充分EN组患者每日平均血糖值(t=1.259,P=0.003)及胰岛素使用量(t=1.479,P=0.001)均明显高于低量EN组,营养费用(t=3.441,P=0.001)、住院总费用(t=2.379,P=0.03)明显高于低量EN组.提示发病初期低量EN在急性肺损伤患者呼吸机脱机成功率、28 d的病死率、呼吸机相关肺炎的发生率以及ICU住院时问方面与充分EN组指标相当,但是可明显降低肠道不耐受现象发生,减少住院费用.
장99례급성폐손상환자안수궤수자표법분위충분장내영양조(충분EN조49례)여저제량장내영양조(저량EN조50례),관찰치료전화치료7d후적전단백、전철단백、담평형、7d여28d탈궤성공솔、28 d병사솔화호흡궤상관폐염발생솔(VAP).관찰량조환자치료과정중구토발생솔、위저류발생솔、복사솔、매천평균혈당치、매천이도소사용량、촉위장동력약물사용빈솔(차수)급ICU주원시간(d)、영양비용、총주원비용.결과현시,치료7d후,충분EN조교저량EN조7d화28 d탈궤성공솔(x2=0.417,P=0.81;x2=0.629,P =0.36) 、28 d림상VAP발생솔(x2=0.235,P=0.16)、28 d병사솔(x2=0.211,P=0.14)급ICU주원시문(=0.591,P=0.17)차이무통계학의의.구토발생솔(x2=3.417,P=0.004)、위저류발생솔(x2=3.592,P=0.003)、복사차수(x2=2.147,P=0.007)、복창발생솔(x2 =3.915,P =0.001)、촉위장동력약사용빈솔(x2=2.316,P=0.002)방면,량조차이유통계학의의.동시,충분EN조환자매일평균혈당치(t=1.259,P=0.003)급이도소사용량(t=1.479,P=0.001)균명현고우저량EN조,영양비용(t=3.441,P=0.001)、주원총비용(t=2.379,P=0.03)명현고우저량EN조.제시발병초기저량EN재급성폐손상환자호흡궤탈궤성공솔、28 d적병사솔、호흡궤상관폐염적발생솔이급ICU주원시문방면여충분EN조지표상당,단시가명현강저장도불내수현상발생,감소주원비용.
A total of 99 patients with acute lung injury (ALI) were randomly divided into initial trophic f and full enteral feeding groups.The regime was maintained for 28 days.The changes were evaluated in the number of ventilator-free days,28-day mortality and incidence of ventilator-associated pneumonia (VAP).And vomiting,gastric residual volumes,constipation and intensive care unit (ICU) stay duration,enteral nutrition costs and total costs were recorded and compared.The number of ventilator-free days (x2 ＝0.417,P=0.81;x2 =0.629,P=0.36),28-day mortality (x2 =0.211,P=0.14),VAP(x2 =0.235,P =0.16) and ICU stay duration (t =0.591,P =0.17) had no significant increases in lower-volume trophic enteral feeding group.The incidence of vomiting (x2 =3.417,P =0.004),gastric retention rate (x2 ＝ 3.592,P =0.003),incidence of diarrhea frequency (x2 =2.147,P =0.007),incidence of abdominal distension (x2 =3.915,P =0.001) and use frequency of gastrointestinal prokinetic drug (x2 =2.316,P =0.002) in fully enteral nutrition (EN) group were higher than those of low volume EN group.There was statistically significant difference.While fully EN patients daily monitoring of the average blood glucose value (t =1.259,P =0.003) and insulin usage (t =1.479,P =0.001) were significantly higher than the low volume EN group,nutritional costs (t =3.441,P =0.001),total cost of hospitalization (t =2.379,P =0.03) were significantly higher than those of low volume EN group.There was statistically significant difference.As compared with full enteral feeding,an initial regime of trophic enteral feeding for up to 6 days did not improve ventilator-free days,28-day mortality,infectious complications or ICU stay duration in ALI patients.However,it was associated with more gastrointestinal tolerance,less enteral nutrition and lower total costs.