营养支持管理在机械通气患者中的临床应用  

Clinical Application of Nutritional Support Management in Patients with Mechanical Ventilation

作　　者：龙训辉[1] 陈健[1] 李国晖[2] 

机构地区：[1]新疆医科大学附属中医医院重症医学科,新疆乌鲁木齐830000 [2]云南省中医医院放射科,云南昆明650021

出　　处：《河北医学》2015年第10期1591-1594,共4页Hebei Medicine

基　　金：卫生部医药卫生科技发展项目;(编号:W2013GJ09)

摘　　要：目的:旨在评价营养支持管理方案指导营养支持治疗对机械通气患者预后的影响。方法:选择2012年1月1日至2013年12月31日入住重症监护病房,且因呼吸衰竭需机械通气的危重症患者共98例,随机分为营养支持组和对照组。检测所有受试者营养支持治疗后第1、7和14天的血清总蛋白(TB)、白蛋白(ALB)、前白蛋白(PA)、丙氨酰氨基转氨酶(ALT)、天冬氨酸氨基转氨酶(AST)和血红蛋白(HGB)。比较两组患者的营养指标、肝功能指标、肠内营养达标率、静脉营养支持比例、平均机械通气时间、平均ICU住院时间及28d病死率。结果:治疗第7天,营养支持组PA水平高于对照组,而AST水平低于对照组,差异有统计学意义(P<0.05);而在营养支持治疗14d后,营养支持组TP、ALB、PA和HGB水平均显著高于对照组,AST和ALT水平显著低于对照组;而且,营养支持组肠内营养达标率显著高于对照组(P<0.05);静脉营养支持比率低于对照组(P<0.05)。此外,与对照组相比,平均机械通气时间和平均ICU住院时间均明显缩短(P<0.05)。结论:营养支持管理方案有助于提高肠内营养达标率,降低静脉营养支持比例,有效改善危重症患者营养状况。Objective： To evaluate the efficacy of nutritional support guided by nutritional support management in patients with mechanical ventilation.Methods： 98 critically ill patients with mechanical ventilation because of respiratory failure in ICU were randomly divided into nutritional support group and control group.Detecting the serum total protein（ TP）,albumin（ ALB）,prealbumin（ PA） and liver function on the lth,7th and 14 th day after nutritional support management. Compared nutrition index,liver function,the rate of achieve nutritional goal,intravenous nutritional support rate,the average time of mechanical ventilation,the average time in ICU and 28 days mortality. Result： PA level in nutritional support group on the 7th day was higher than control group,AST was lower than control group.On the 14 th day,the level of TP,ALB,PA and HGB in nutritional support group was higher than control group,the level of AST and ALT was lower than control group. And the rate of achieve nutritional goal in nutritional support group was higher than control group,intravenous nutritional support rate was lower in nutritional support group. Futhermore,compared to control group,the average time of mechanical ventilation,the average time in ICU of nutritional support groupwere shorter.Conclusion： Nutritional support management programmes can shorten the time of achieve nutritional goal,improve the rate of achieve nutritional goal,reduce the rate of intravenous nutritional support,so as to more effectively improve nutritional status of the patients.

关 键 词：机械通气 肠内营养 肠外营养 

分 类 号：R459.3[医药卫生—治疗学]