不同剂量早期肠内营养对急性胃肠功能障碍患者的影响  

Different doses of early enteral nutrition for patients with acute gastrointestinal dysfunction

作　　者：孔岩溪 徐兴伟[1] 习丰产[1] 虞文魁[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)解放军普通外科研究所,南京医学硕士研究生210002

出　　处：《医学研究生学报》2015年第4期373-376,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81270884)

摘　　要：目的急性胃肠功能障碍是危重患者常见病症,早期肠内营养(Enteral nutrition,EN)被广泛应用于危重患者,但其应用剂量仍具有争议。文中旨在观察不同剂量早期EN对急性胃肠功能障碍患者喂养不耐受情况、以及新发感染等并发症、炎性指标及预后的影响。方法选取符合急性胃肠功能障碍Ⅱ级标准且需EN支持的危重患者120例,按随机数字表法分为标准剂量组(n=60)和低剂量组(n=60)。标准剂量组EN速度20 m L/h,每隔12小时根据耐受性增加10 m L/h,第3天若仍未达到热卡60%者,添加肠外营养(Parenteral nutrition,PN)以达到目标热卡;低剂量组行EN速度20 m L/h,连续7 d,第3天开始添加PN达到目标热卡,7 d后EN逐渐加至全量。比较2组患者的ICU天数和住院天数及病死率、器官支持(机械通气、持续肾脏替代治疗及血管活性药物)的天数、7 d及28 d新发感染率、7 d内喂养不耐受的发生率及C-反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitonin,PCT)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)等炎性指标水平。结果低剂量组与标准剂量组的ICU天数和住院天数及病死率、器官支持天数、7 d及28 d新发感染率均无统计学差异(P>0.05);第7天,低剂量组喂养不耐受的发生率明显低于标准剂量组(13.3%vs 36.7%,P<0.05);第1、3、7天,标准剂量组CRP水平为[(5.83±0.59)、(15.83±1.19)和(33.16±4.51)ng/L],PCT水平为[(4.55±0.67)、(10.41±1.99)和(17.49±3.87)ng/m L];低剂量组CRP水平为[(5.90±0.72)、(16.52±3.09)和(32.11±4.33)ng/L),PCT水平为[(4.71±1.25)、(10.63±2.21)和(16.89±3.39)ng/m L],2组均随天数增加逐渐升高,组内不同时间点比较的差异均有统计学意义(P<0.05),2组的TNF-α和IL-6水平同样随着天数增加依次升高,组内不同时间点比较,差异均有统计学意义(P<0.05)。结论低剂量早期EN可提高急性胃肠功能障碍患者喂养耐受性,但对患者�Objective Acute gastrointestinal dysfunction （AGD） is a common problem in critically ill patients, for whomearly enteral nutrition （ EN） is widely used, but its application dosage remains controversial.This study aimed to observe the influence of dif-ferent doses of early EN on acute gastrointestinal tolerance, new infections and other complications, inflammation indexes, and prognosis in AGD patients. Methods We selected 120 critically ill patients that met thecriteria of class-ⅡAGD and needed EN support andequal-ly randomized them intoa standard-dose and a low-dose ENgroup.The former group received EN at 20 mL/h, with an addition of 10 mL/h every 12 hours according to the tolerance and supplemented byparenteral nutrition （PN） to achieve the target calories（60%） on the 3 rd day, while the latterat 20 mL/h for 7 days, supplemented by PN to achieve the target calories on the 3 rd day and from the 7 th day gradu-ally increased to the full volume.We recorded the patients′ICUdays, hospitaldays, mortality rate, organ function support days, incidence of feeding intolerance within 7 days, incidence of new infections within 7 and 28 days, and levels of C-reactive protein （CRP）, procalci-tonin （PCT）, tumor necrosis factor-α（TNF-α） and interleukin-6 （IL-6） and compared these indexes between the two groups. Resulst There were no statistically significant differences between the low -and standardd-ose EN groups in the patients′ICU days, hospital days, mortality rate,organ function support days, or incidence of new infections within 7 and 28 days （ P＆gt;0.05） .The incidence of feeding intol-erance on the 7 th day was significantly lower in the low-dose than in the standard-dose EN group （ 13.3 vs 36.7%, P30.05）.On the 1st, 3rd, and 7 th day, the level of CRP was （5.90±0.72）, （16.52± 3.09） , and （ 32.11 ±4.33 ） ng/L, respectively, in the low-dose groupversus（5.83±0.59）, （15.83±1.19）, and （33.16±4.51）ng/L in the standard-dose group, while that of PC

关 键 词：标准剂量 低剂量 早期肠内营养 急性胃肠功能障碍 新发感染 

分 类 号：R656[医药卫生—外科学]