摘要
目的:探究危重症病人经空肠管、胃管行早期肠内营养(EEN)的疗效及安全性。方法:选取2019年12月至2021年12月中国人民解放军联勤保障部队第九〇〇医院普通外科重症ICU病区收治的60例危重症病人,随机分成观察组(A组,n=31)及对照组(B组,n=29),A、B组分别用空肠管和胃管行EEN,比较2 w内营养指标(Alb、Pa、CCR)、炎症指标(CRP、IL-6、PCT)、和并发症等指标。结果:营养指标,第7天、14天,A组Alb、Pa较B组高,差异有统计学意义(P<0.05),第14天,A组NRS 2002、NUTRIC评分较B组低,差异有统计学意义(P<0.05);炎症指标,第7天,A组IL-6低于B组,差异有统计学意义(P<0.05),第14天,A组CRP、IL-6、PCT均低于B组,差异有统计学意义(P<0.05);并发症等指标,A组EN耐受情况、EN达到60%目标量时间、反流率及14 d的APACHE II评分低于B组,差异有统计学差异(P<0.05)。结论:危重症者经空肠管行ENN是安全、有效的,特别是对改善营养状况、EN耐受及降低反流率等方面优于胃管,值得在临床推广。
Objective:To investigate the efficacy and safety of early post-pyloric enteral nutrition in adult critically ill patients.Methods:Sixty adult critically ill patients from December 2019 to December 2021were included in this study.The patients were randomly divided into group A(post-pyloric feeding n=31)or group B(nasogastric feeding n=29).Clinical parameters,biochemical nutritional status(Alb,Pa,CCR),serum inflammatory factors levels(CRP,IL-6,PCT),incidence of complications(abdominal distention,diarrhea,gastroesophageal reflux,and the interval between initiation of enteral nutrition to reach of 60%of the nutrition goal)and clinical prognosis(VAP/HAP,CFR)were evaluated and compared between the two groups at admission,day 4,day 7 and day 14 after admission.Results:For nutritional parameters,the level of Alb and Pa at day 7,14 in Group A were significantly lower than Group B,while the value of NRS 2002 and NUTRIC score at day 14 in Group A was significantly higher.For serum inflammatory markers,the level of IL-6 at day 7 and 14,CRP and PCT level at day 14 in Group A were significantly lower.For incidence of complications and clinical outcomes,the incidence of feeding intolerance and gastroesophageal reflux,the interval between initiation of enteral nutrition to reach of 60%of the nutrition goal,and APACHE II score at day 14 were significantly lower in Group A.Conclusion:In comparison with nasogastric feeding,early enteral nutrition via post-pylori route could improve the nutrition status,the tolerance to enteral nutrition,and reduce the incidence of gastroesophageal reflux in adult critically ill patients.
作者
何杨
高琴
林晨
侯志冰
张再重
宋京翔
王烈
HE Yang;GAO Qin;LIN Chen;HOU Zhi-bing;ZHANG Zai-zhong;SONG Jing-xiang;WANG Lie(Department of General Surgery,the 900th Hospital of The Joint Logistics Support Force of Chinese PLA,Fuzhou 350000,Fujian,China)
出处
《肠外与肠内营养》
CAS
CSCD
北大核心
2023年第1期14-19,共6页
Parenteral & Enteral Nutrition
基金
福建省自然科学基金面上项目(2020J01113&2021J011262)
全军医学科技青年培育项目拔尖项目(21QNPY138)
联勤保障部队第九〇〇医院院内课题(2020L12)
关键词
危重症
幽门后喂养
早期肠内营养
Critically ill
Postpyloric feeding
Early enteral nutrition
作者简介
第一作者:何杨,主治医师,医学博士,从事消化道肿瘤的诊疗及营养治疗的应用。E-mail:272039737@qq.com;共同第一作者:高琴,副主任医师,医学博士,从事普外科疾病临床与基础研究。E-mail:46064155@qq.com;通讯作者:宋京翔,E-mail:46064155@qq.com
