肠内营养启动时机对ARDS机械通气患者疗效及预后的影响  

Influence of enteral nutrition initiation timing on curative effect and prognosis of acute respiratory distress syndrome patients with mechanical ventilation

作　　者：郭焱[1] 程静 李永江 Guo Yan;Cheng Jing;Li Yongjiang(Department of Intensive Care Unit,the First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China;Department of Intensive Care Unit,the Sixth Division Hospital of Xinfiang,Wujiaqu 831300,Xinjiang,Chin)

机构地区：[1]山西医科大学第一医院重症医学科,山西太原030001 [2]新疆维吾尔自治区五家渠市,新疆兵团农六师医院重症医学科,831300

出　　处：《中华危重病急救医学》2018年第6期573-577,共5页Chinese Critical Care Medicine

基　　金：山西省应用基础研究计划项目（201601D102076）

摘　　要：目的探讨肠内营养（EN）启动时机对急性呼吸窘迫综合征（ARDS）机械通气患者疗效及预后的影响。 方法采用回顾性研究方法，选择2016年1月至2017年12月援疆期间新疆兵团农六师医院重症医学科（ICU）收治的116例ARDS机械通气成人患者，这些患者入科时性别、年龄、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）均无差异。根据启动EN时机将患者分为早期肠内营养组（E-EN组，66例，入ICU 48 h内启动EN）和晚期肠内营养组（L-EN组，50例，入ICU 7 d或之后启动EN），两组患者均可在EN启动后3-5 d达到标准营养量。收集患者治疗前及治疗1、3、7、10、14 d的营养指标〔白蛋白（ALB）、前白蛋白（PA）〕、肝功能〔总胆红素（TBIL）〕、感染指标〔降钙素原（PCT）〕、胰岛素用量、呼吸力学指标及肺功能〔气道峰压（PIP）、气道平台压（Pplat）、平均气道压（MPaw）、有效静态总顺应性（Cst）、氧合指数（PaO2/FiO2）〕；危重症评分〔APACHEⅡ、多器官功能障碍评分（MODS）、Muray肺损伤评分和全身炎症反应综合征（SIRS）评分〕；机械通气时间、ICU住院时间、多器官功能障碍综合征发生率、14 d病死率、ICU住院费用。 结果两组治疗前生化指标、呼吸力学指标、肺功能、危重症评分等指标比较差异均无统计学意义。与治疗前比较，两组治疗后ALB、PA明显升高，TBIL、PCT明显降低，胰岛素用量明显减少，PIP、Pplat、MPaw明显下降，Cst、PaO2/FiO2明显升高，各危重症评分明显降低。与L-EN组比较，E-EN组治疗后TBIL、PCT更低〔TBIL（μmol/L）：13.21±1.03比29.02±1.38，PCT（ng/L）：5.36±1.58比11.33±1.95〕，胰岛素用量更少（U：16.37±1.01比27.01±1.92），PIP、Pplat、MPaw更低〔PIP（cmH2O，1 cmH2O=0.098 kPa）：17.7±3.5比22.5±4.3，Pplat（cmH2O）：10.5±1.4比15.6±1.2，MPaw（cmH2O）：5.5±0.7比8.2±0.8〕，Cst、PObjectiveTo explore the effect of enteral nutrition （EN） initiation time on the treatment and prognosis of acute respiratory distress syndrome （ARDS） patients with mechanical ventilation.MethodsA retrospective study was conducted. 116 adult ARDS patients with mechanical ventilation admitted to the intensive care unit （ICU） of the Sixth Division Hospital of Xinjiang from January 2016 to December 2017 were enrolled. There was no difference in gender, age, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） at admission. Patients were divided into early enteral nutrition group （E-EN group, 66 cases, starting EN within 48 hours） and late enteral nutrition group （L-EN group, 50 cases, starting EN after 7 days later） according to the EN initiation time. Both groups of patients achieved the standard nutrition after 3-5 days of EN. Nutritional indicators [albumin （ALB）, pre-albumin （PA）], liver function [total bilirubin （TBIL）], infection index [procalcitonin （PCT）], insulin dosage, respiratory mechanics and pulmonary function [airway peak pressure （PIP）, airway plateau pressure （Pplat）, mean airway pressure （MPaw）, effective static total compliance （Cst）, oxygenation index （PaO2/FiO2）], critical scores [APACHEⅡ, multiple organ dysfunction score （MODS）, Murray lung injury score, and systemic inflammatory response syndrome （SIRS） score], duration of mechanical ventilation, the length of ICU stay, incidence of multiple organ dysfunction syndrome, 14-day mortality, and ICU hospitalization expenses were collected before treatment and 1, 3, 7, 10, 14 days after treatment.ResultsThere was no difference in biochemical indicators, respiratory mechanics, pulmonary function, or critical scores between the two groups before ICU treatment. Compared with before treatment, ALB and PA were significantly increased, TBIL and MPaw were significantly decreased, insulin dosage was significantly decreased, PIP, Pplat, MPaw were significantly decreased, Cst and

关 键 词：急性呼吸窘迫综合征 机械通气 早期肠内营养 晚期肠内营养 疗效 预后 

分 类 号：R563.8[医药卫生—呼吸系统]