APACHEⅢ评分应用于危重症患者肠内营养方式的选择  

APACHEⅢ Score in Selecting Enteral Nutrition Program for Critical Patients

作　　者：潘夏蓁[1] 方希敏[1] 林碎钗[1] 屈敏吉[1] 何春雷[1] 

机构地区：[1]温州医学院附属第一医院急诊科,浙江温州325000

出　　处：《解放军护理杂志》2011年第14期13-15,19,共4页Nursing Journal of Chinese People's Liberation Army

基　　金：温州市科技委员会项目(Y20070171)

摘　　要：目的探讨应用APACHEⅢ评分选择危重症患者肠内营养输注方式的可行性。方法选择某三级甲等医院4个监护室共80例接受鼻饲的成年患者,对其中40例患者进行1周的持续鼻饲后改为1周的间歇鼻饲,另40例患者进行1周的间歇鼻饲后改为1周的持续鼻饲,并分别在这两个阶段对患者进行APACHEⅢ评分和胃肠道相关并发症、胃液pH值的监测。结果患者APACHEⅢ评分≥60分时,持续鼻饲阶段腹泻、胃潴留的发生率均低于间歇鼻饲阶段,差异有统计学意义(χ2=7.43,χ2=7.12,P<0.01),持续鼻饲阶段胃液pH值高于间歇鼻饲阶段,差异有统计学意义(t=2.568,P<0.01);当患者APACHEⅢ评分<60分时,持续鼻饲阶段的胃液pH值高于间歇鼻饲阶段,差异有统计学意义(t=3.894,P<0.01)。结论 APACHEⅢ评分高于60分的危重症患者,宜选用持续鼻饲;APACHEⅢ评分低于60分的患者,宜选用间歇鼻饲。Objective To investigate the feasibility of selection of critical patients＇ enteral nutrition by APACHEⅢ score.Methods Eighty patients who were supported by nasogastric（NG） feeding were chosen from 4 ICU in a grade-Ⅲ level-A hospital.Half of the patients were given continuous NG feeding for a week first and then switched to intermittent NG feeding for another week.The rest of the patients were given intermittent NG feeding for a week first and then continuous NG feeding for another week.The patients were scored with APACHEⅢ and the incidence of complications correlated with gastrointestinal tract and the pH value of the gastric juice were recorded during the two stages.Results When APACHEⅢ scores of the patients were not lower than 60,the incidence of diarrhea and gastric retention during the stage of continuous NG feeding was significantly lower than that during the stage of intermittent NG feeding（χ2 =7.43,χ2 =7.12,P0.01）;the pH value of the gastric juice during the stage of continuous NG feeding was significantly higher than that during the stage of intermittent NG feeding（t=2.568,P0.01）.When APACHEⅢ scores of the patients were lower than 60,the pH of the gastric juice during the stage of continuous NG feeding was significantly higher than that during the stage of intermittent NG feeding（t=3.894,P0.01）.Conclusion The critical patients whose APACHEⅢ score is not lower than 60 should be given continuous NG feeding,and those whose APACHEⅢ score is lower than 60 should have intermittent NG feeding.

关 键 词：探讨应用APACHEⅢ评分 肠内营养 间歇鼻饲 持续鼻饲 危重症患者 

分 类 号：R197.323[医药卫生—卫生事业管理]