危重患者急性胃肠损伤早期肠康复的效果评价  

Evaluation to earlier intestinal rehabilitation of acute gastrointestinal injury in critically sick patients

作　　者：柳红梅[1] 徐冬梅[1] 王淑玲[1] 匡荣光[1] 王建文[1] 

机构地区：[1]山东大学附属千佛山医院综合科,济南市250014

出　　处：《中华全科医学》2015年第1期112-114,共3页Chinese Journal of General Practice

摘　　要：目的评价对急性胃肠损伤(AGI)患者进行早期肠康复的效果,提出进一步完善的意见。方法调查住院危重患者AGI的发病和肠内营养的使用情况及其效果,患者涉及ICU、神经外科、胸外科等,患者未行胃肠道手术。早期将各种必需的药物与营养制剂,通过肠内途径应用于需要营养治疗的患者,促进肠道多种功能的代偿,改善肠黏膜屏障作用、减少肠内毒素和细菌的易位,满足机体对营养物质的需要。结果 56名危重患者在急性疾病阶段及时进行了肠康复治疗,促进患者顺利渡过危急病情。经严格统计分析后认为效果满意。早期肠康复对术后并发症起到了预防作用。除提供机体能量外,在维护肠功能、改善肠黏膜屏障、减少肠内毒素、阻止细菌易位、调节肠道微生态和降低肠源性感染等方面也起到了较好的作用。患者的胃内容物一次抽吸量平均为(280.00±10.17)ml/d。所有患者未发生喂食物误吸。结论 AGI患者应及早进行肠康复治疗和护理,胃内容物一次抽吸的定量管理对临床选择肠内营养的时机有较好的指导意义。急性胃肠损伤新概念的提出和分级管理有利于危重患者的康复,对肠内营养的剂量和逐步增加的时限应进一步研究。Objective To evaluate the effect of earlier intestinal rehabilitation of acute gastrointestinal injury （AGI） in critical patients and put forward further opinions. Methods 56 critically ill inpatients without gastrointestinal surgery from ICU ,Department of Neurosurgery and Thoracic Surgery were investigated by professionals for incidence of AGI and the utilization of enternal nutrition （EN）. Results The earlier intestinal rehabilitation according to AGI guidelines was performed in the acute period. The volume of once aspirated gastric contents were （280.00 ~ 10.17 ） ml/d. No aspiration of food occurred in all patients. Conclusion It is important to put forward early intestinal rehabilitation and nursing inter- ventions for AGI patients. The volume of once aspirated gastric contents can guide the timing of enteral nutrition. The clas- sification can improve the management of the patients with acute gastrointestinal injury ,and is conducive to the rehabilita- tion of critical patients. The dose and increment deadline for EN need to be further studied.

关 键 词：急性胃肠损伤 康复 危重患者 

分 类 号：R57[医药卫生—消化系统] R493[医药卫生—内科学]