CAJ | 학술논문

目的：评价早期不同营养方式对老年呼吸机相关性肺炎( VAP)患者的治疗效果的影响。方法将90例确诊的VAP患者随机分为肠内营养(EN)组(30例)和肠外营养(PN)组(30例)及对照组(30例)。在给予常规治疗的基础上,EN和PN组接受等氮等热量营养支持,而对照组仅给予常规流质饮食及静脉营养。比较各组营养支持2周后营养状态、临床有效率、撤机时间、住院天数及不良反应发生率的差异。结果各组患者营养支持后血清血红蛋白水平及臂肌围变化无明显差异(P>0．05),但血清白蛋白和总蛋白水平有所升高,其中,EN组明显高于其他两组( P <0．05),同时炎性指标则明显降低, EN 组低于其他两组( P <0．05),但是PN组与对照组间无统计学差异。 EN组临床治疗有效率和脱机成功率明显高于PN组及对照组,机械通气时间和住院天数则明显低于PN组及对照组(P<0．05),而PN组与对照组无差异,各组间不良反应发生率无统计学意义(P>0．05)。结论早期营养支持可以提高VAP患者营养状态,其中EN效果最显著,更有助于改善VAP患者临床治疗效果。
목적：평개조기불동영양방식대노년호흡궤상관성폐염( VAP)환자적치료효과적영향。방법장90례학진적VAP환자수궤분위장내영양(EN)조(30례)화장외영양(PN)조(30례)급대조조(30례)。재급여상규치료적기출상,EN화PN조접수등담등열량영양지지,이대조조부급여상규류질음식급정맥영양。비교각조영양지지2주후영양상태、림상유효솔、철궤시간、주원천수급불량반응발생솔적차이。결과각조환자영양지지후혈청혈홍단백수평급비기위변화무명현차이(P>0．05),단혈청백단백화총단백수평유소승고,기중,EN조명현고우기타량조( P <0．05),동시염성지표칙명현강저, EN 조저우기타량조( P <0．05),단시PN조여대조조간무통계학차이。 EN조림상치료유효솔화탈궤성공솔명현고우PN조급대조조,궤계통기시간화주원천수칙명현저우PN조급대조조(P<0．05),이PN조여대조조무차이,각조간불량반응발생솔무통계학의의(P>0．05)。결론조기영양지지가이제고VAP환자영양상태,기중EN효과최현저,경유조우개선VAP환자림상치료효과。
Objective To investigate the effect of early different nutrition support therapy on prognosis of elderly patients with ventilator-associated pneumonia ( VAP) . Methods A total of 90 VAP patients were randomly divided into the enteral nutrition (EN) group, the parenteral nnutrition (PN) group and the normal diet (control) group, 30 cases in every group. On the basis of conventional therapy, the EN and PN group received considerable en-ergy and nitrogen intake, and the control group received normal diet. The levels of nutritional parameter, clinical symptom, duration of mechanical ventilation and the duration of hospital stay were observed 2 weeks after nutrition support. Results The serum hemoglobin levels and upper arm muscle circumference had no significant difference a-mong the three group (P>0. 05). The serum albumin, total protein and transferrin levels increased in all groups, but the improvement was more pronounced in the EN group than the other two groups (P<0. 05), which showed no significant difference between the PN group and the control group. The levels of inflammation reduced in all groups, and the decrease was more significant in the EN group than the other two groups ( P<0. 05 ) . The clinical effective rate was higher and the time of using ventilator and duration of hospital stay were shorter in the EN group than in the other two groups ( P<0. 05 ) . The adverse reaction had no significant difference in the three group ( P >0. 05 ) . Conclusion Early nutrition support can enhance the nutritional levels of patients with VAP, and the enteral nutrition support is more helpful to improve the clinical treatment effect of patients with VAP.