营养支持对机械通气患者营养状况和免疫功能的影响  

The effect of different nutritional supportive treatment on the nutritional and immune states in patients with mechanical ventilation

作　　者：姚莉[1,2] 赵晶晶[1,2] 周小妹[1,2] 凌高强[1,2] 李萌[1,2] 

机构地区：[1]安徽医科大学第四临床学院 [2]合肥市第二人民医院重症医学科,安徽合肥230011

出　　处：《临床肺科杂志》2011年第8期1192-1193,共2页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨不同营养支持途径对机械通气患者的营养状况和免疫功能的影响。方法选择2008年7月至2010年12月入住我院重症监护病房(ICU)机械通气危重症患者48例,随机分为全肠外营养(TPN)组和肠内营养(EN)组,并对两组患者营养支持前和10 d后各项营养指标及免疫球蛋白变化、机械通气时间及并发症等进行比较分析。结果 10 d后,EN组患者与治疗前比较血清总蛋白(PT)、ALB、PA和HB水平明显上升(P<0.05),TPN组病人也较治疗前有所上升(P>0.05);与TPN组比较上述指标上升更明显(P<0.05);EN组免疫指标:IgA、IgM较营养支持前明显升高,与TPN组比较P<0.05;EN组与TPN组比较,机械通气时间缩短,腹泻、肺部感染、导管相关感染、上消化道出血、肝功能损害、高血糖等并发症明显降低,均P<0.05。结论肠内营养支持可以改善机械通气危重症患者的营养状况和免疫功能,促进患者康复。Objective To investigate the effect of different nutritional supportive treatment on the nutritional and immune states in patients with mechanical ventilation.Methods Forty eight critical patients with mechanical ventilation admitted to the Intensive Care Unit from July 2008 to September 2010 were randomly assigned into the total parenteral nutrition（TPN） group and the enteral nutrition（EN） group.The nutritional states,immunoglobulin levels,the length of mechanical ventilation and complications were compared before and after the treatment.Results After 10 days of treatment,the EN group showed significant difference than before the treatment in the levels of PT,ALB,PA and HB（P0.05）.Nutritional states were improved in the TPN group but there was no significant difference（P0.05）.Compared with the TPN group,there was significant improvement in the nutritional states（P0.05）.The levels of immune indexes IgA and IgM in the EN group were improved and significantly different from the TPN group.Also the group differences were seen in the length of mechanical ventilation,the incidence of diarrhea,pulmonary infection,catheter-related infection,upper gastrointestinal bleeding,liver function damage and hyperglycemia（P0.05）.Conclusions Enteral nutrition can improve the nutrition and immunity of critical patients with mechanical ventilation,help rehabilitation of patients and is a safe and effective treatment.

关 键 词：肠内营养 肠外营养 机械通气 营养指标 免疫功能 

分 类 号：R459.3[医药卫生—治疗学]