独参汤鼻饲联合早期幽门后置管+空肠营养治疗ICU重症随机平行对照研究被引量：2

Randomized Parallel Control Study of the Combination of Nasal Feeding and Early Pyloric Catheterization plus Jejunum Nutrition in the Treatment of ICU

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摘要 [目的]观察独参汤鼻饲联合早期幽门后置管+空肠营养治疗ICU重症疗效。[方法]使用随机平行对照方法,将62例住院患者按病志号抽签方法随机分为两组,控制原发病、氧疗或机械通气、维持内环境等。对照组31例早期幽门后置管+空肠营养,入ICU时,胃复安10mg静推,10min后缓慢插入CORFLO胃肠营养管,插管过程听诊法、吸引术、真空试验及导丝回抽试验检测导管尖端位置,推进体内85~120cm,腹部平片定位,确定营养管在幽门后,输入肠内营养乳剂(整蛋白、纤维型)500mL/d,初始速度20mL/h,无不良反应可逐渐增至40~60mL/h。治疗组31例独参汤,2g生晒参粉+100mL沸水冲开,液体30~35℃时鼻饲,1次/d;早期幽门后置管+空肠营养同对照组。连续治疗10d为1疗程。观测血乳酸(LAC)、白细胞(WBC)、白蛋白(ALB)、C反应蛋白(CRP)、急性生理慢性健康(APACHE-Ⅱ)评分、不良反应。治疗1疗程(10d),随访1个月,判定疗效。[结果]血乳酸(LAC)、白细胞(WBC)、白蛋白(ALB)、C反应蛋白(CRP)、急性生理与慢性健康(APACHE-Ⅱ)评分两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。机械通气时间、ICU住院时间、死亡率治疗组优于对照组(P<0.01)。[结论]独参汤鼻饲联合早期幽门后置管+空肠营养治疗ICU重症,改善(APACHE-Ⅱ)评分,缩短机械通气及ICU住院时间,降低死亡率,疗效满意,值得推广。 [Objective] To observe the curative effect of the combination of the nasal feeding and the early pylorus catheterization and jejunum nutrition in the treatment of ICU. [Methods] Randomized parallel control method was used to divide 62 hospitalized patients into two groups according to the number of diseases, and control the primary disease, oxygen therapy or mechanical ventilation, and maintain the internal environment. The control group of 31 cases of early post pyloric tube＋enteral nutrition, ICU, metoclopramide 10 mg intravenously, 10 min slowly after insertion of CORFLO gastrointestinal nutrition tube intubation during auscultation, aspiration, vacuum test and wire pulling test catheter tip position, promote the in vivo 85-120 cm, abdominal plain film positioning sure, nutrition tube in the pyloric, enteral nutritional Emulsion input（the whole protein and fiber type） 500 mL/d, 20 mL/h initial speed, no adverse reactions can be gradually increased to 40-60 mL/h. The treatment group of 31 cases of Dushentang, 2 g ginseng powder made＋100 mL boiling water at 30-35 DEG C, liquid feeding, 1 times/d; early post pyloric tube＋enteral nutrition with the control group. The continuous treatment of 10 d was 1 courses. Blood lactic acid（LAC）, white blood cell（WBC）, albumin（ALB）, C reactive protein（CRP）, acute physiological chronic health（APACHE-） score and adverse reactions were observed. The 1 course of treatment（10 d） was treated and followed up for 1 months to determine the curative effect. [Results] Blood lactate（LAC）, white blood cell（WBC）, albumin（ALB）, C reactive protein（CRP）, acute physiology and chronic health（APACHE-II） score were improved in two groups（P〈0.01）, and the improvement in treatment group was better than that in control group（P〈0.01）. The time of mechanical ventilation, the time of ICU hospitalization and the mortality rate in the treatment group were better than those in the control group（P〈0.01）. [Conclusion] Single ginseng soup and nasogastric feeding combined with early pyloric posterior catheter plus jejunal nutrition can improve ICU（APACHE-II） score, shorten mechanical ventilation and ICU hospitalization time, and reduce mortality. It is worth promoting.

作者陈新玉官冬娣赖汝标涂建强华县龙江权锋潘佩玲 CHEN Xin yu;GUAN Dongdi;LAI Rubiao;XU Jianqiang;HUA Xianlong;JIANG Quanfeng;PAN Peiling(Wengyuan County People＇s Hospital,the Department of Severe Medieine,Wengyuan 512600,Guangdong,China)

机构地区广东省翁源县人民医院重症医学科

出处《实用中医内科杂志》 2018年第3期36-39,共4页 Journal of Practical Traditional Chinese Internal Medicine

基金韶关市科技计划项目-创新基金(社会发展)(2016ws39)~~

关键词 ICU重症空肠营养独参汤鼻饲早期幽门后置管肠内营养乳剂(整蛋白、纤维型) 血乳酸白细胞白蛋白 C反应蛋白急性生理慢性健康评分(APACHE-Ⅱ) 机械通气时间 ICU住院时间死亡率 CORFLO胃肠营养管中西医结合治疗随机平行对照研究 severe ICU enteral nutrition Dushentang nasal feeding early post pyloric tube enteralnutritional emulsion （whole protein, fiber type） blood lactic acid leukocyte albumin C reactive protein acute physiology and chronic health evaluation （APACHE- II） mechanical ventilation ICU hospitalizationtime mortality CORFLO gastrointestinal nutrition tube integrated traditional Chinese and western medicinetherapy randomized controlled study