机械通气患者的肠道氨基酸支持与应激性胃炎  

Enteral amino acid support for stress gastritis in mechanically ventilated patients

作　　者：秦英智[1] 王士泳[1] 陈颖 徐磊[1] 王禹[1] 

机构地区：[1]天津市第三中心医院ICU

出　　处：《中国危重病急救医学》1997年第1期24-25,共2页Chinese Critical Care Medicine

基　　金：天津市卫生局科研项目

摘　　要：目的：研究在机械通气期间，肠道营养中加入肺心氨（ＢＣＡＡ、ＡＬＡＳＥＲＡＲＧＧＬＵ）对预防应激性胃炎发生的效果。方法：采用对照研究的方法，对４４例机械通气患者（男２３例，女２１例，年龄５６±１６岁，机械通气时间１２±２１天），均下胃管监测大便潜血及观察胃液颜色、潜血以诊断应激性胃炎。上机后均给予Ｈ２受体阻断剂或质子泵抑制剂以碱化胃液，术后患者采用肠道外营养（ＴＰＮ）；非手术患者采用肠道营养（ＥＮ）或ＥＮ与ＴＰＮ结合方式，肺心氨（１２～２０ｇ／ｄ）加到混合奶中管饲。结果：加用肺心氨者应激性胃炎的发生率（２５％）明显少于未用者（６７％）Ｐ＜０．０１。结论：机械通气非手术患者应及早恢复肠道营养，同时应给予肠道氨基酸支持以预防胃肠功能衰竭。Objective:To use CorPulmonale Amino Acids(BCAA,ALA,SER,ARG and GLU) in the parenteralnutrition to prevent stress gastritis during mechanical ventilation.Methods:A controlled prospective study was undertaken in 44 patients who needed mechanical ventilation.The design was a controlled,prospective.All patients took nasogastric tube in order to detect occult and overt bleeding for diagnosing stress gastritis.During mechanical ventilation,H 2blockers and proton pump inhibitor were administered for alkalization of gastric juice.Postoperative patients took parenteral nutrition,the others took either enteral feeding or enteral plus parenteral nutrition.CorPulmonale Amino Acid was added in the mixed milk Ⅰ or Ⅱ and administered via the nasogastrc tube;the dosage was 12-20g per day.Results:As compared with th simple use of mixed milk,the morbidity of stress gastritis was in the was significantly decreased( P <0 01)when Cor Pulmonale Amino Acids were given together with the mixed milk.However the morbidity of stress gastritis was still comparatively high when gastric juice was alkalized only.Conclusions:Enteral feeding should be resumed as early as possible in mechanically ventilated patients,and enteral amino acids employed to prevent gastrointestinal failure.This therapy will significantly improve the rate of sucess of emergency treatment in mechanically ventilated patients.

关 键 词：机械通气 肠道营养 氨基酸 应激性胃炎 

分 类 号：R573.3[医药卫生—消化系统]