重度心力衰竭机械通气患者早期肠内营养的价值  

Value of early enteral nutrition in patients with severe heart failure undergoing mechanical ventilation

作　　者：马丹女 陆军 王飞 赵滋苗 叶肖琳 丁月平 曾文清 戴飞飞 楼金杰 Ma Dannyu;Lu Jun;Wang Fei;Zhao Zimiao;Ye Xiaolin;Ding Yueping;Zeng Wenqing;Dai Feifei;Lou Jinjie(Department of Intensive Care Unit,Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou 310005,Zhejiang,China)

机构地区：[1]浙江中医药大学附属第二医院重症医学科,浙江杭州310005

出　　处：《中华危重病急救医学》2019年第7期903-905,共3页Chinese Critical Care Medicine

基　　金：浙江省中医药科技计划项目(2015ZA104).

摘　　要：目的观察早期肠内营养(EEN)对重度心力衰竭(心衰)机械通气患者营养指标及临床转归的影响.方法选择2017年5月至2018年4月浙江中医药大学附属第二医院重症加强治疗病房(ICU)收治的34例重度心力衰竭(心功能Ⅲ~Ⅳ级)合并肺部感染需机械通气患者,随机分为EEN组和延迟肠内营养(DEN)组,每组17例.两组患者均给予常规治疗,包括机械通气、改善心功能、抗感染、重要器官功能保护、调控血糖、调整电解质及酸碱平衡.EEN组在入住ICU48h内行肠内营养(EN);DEN组于渡过早期应激阶段,生命体征平稳(入住ICU48h后)开始EN.比较两组患者入ICU时及治疗7d血清B型钠尿肽(BNP)、C-反应蛋白(CRP)、营养指标和肝功能指标的变化,记录患者达EN目标所需时间、机械通气时间、ICU住院时间及28d病死率,同时观察患者并发症的发生情况.结果两组患者入ICU时血清BNP、CRP、营养指标和肝功能指标比较差异均无统计学意义;治疗7d,两组BNP、CRP均较入ICU时显著下降〔BNP(ng/L):EEN组为592.1±370.9比2517.7±1163.4,DEN组为621.9±418.8比2251.5±1006.8;CRP(mg/L):EEN组为46.0±19.6比59.8±22.5,DEN组为40.5±18.8比61.2±24.6,均P<0.05〕,而血前白蛋白(PA)、转铁蛋白(TF)均较入ICU时显著升高〔PA(g/L):EEN组为0.18±0.05比0.15±0.06,DEN组为0.17±0.04比0.12±0.06;TF(g/L):EEN组为1.6±0.4比1.5±0.4,DEN组为1.7±0.5比1.4±0.5,均P<0.05〕;但两组间治疗后上述各项指标比较差异均无统计学意义(均P>0.05).两组治疗后肝功能指标均无明显变化.两组均顺利完成EN治疗,部分患者出现不同程度的腹胀和腹泻,经减慢输注速度、辅以胃肠动力药及肠道菌群调整药物等常规处理后均缓解.EEN组患者达EN目标所需时间明显早于DEN组(h:42.4±10.2比53.8±17.1,P<0.05),机械通气时间(d:14.2±8.7比13.4±7.9)、ICU住院时间(d:17.8±6.7比18.3±5.6)及28d病死率〔5.9%(1/17)比11.8%(2/17)〕与DEN组比较差异均无统计学Objective To observe the effect of early enteral nutrition (EEN) on nutritional indicators and clinical outcomes in patients with severe heart failure undergoing mechanical ventilation. Methods Thirty-four patients with severe heart failure (grade Ⅲ-Ⅳ of cardiac function) and pulmonary infections undergoing mechanical ventilation admitted to intensive care unit (ICU) of Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from May 2017 to April 2018 were enrolled. They were randomly divided into EEN group and delayed enteral nutrition (DEN) group. Both groups were given routine treatment, including mechanical ventilation, improvement of cardiac function, anti-infection, protection of vital organ function, regulation of blood sugar and adjustment of electrolyte and acid-base balance. The patients in EEN group received enteral nutrition (EN) within 48 hours after ICU admission, and in DEN group, EN was started after the patients had spent the early stage of stress and had stable vital signs (48 hours after ICU admission). The changes in serum B-type natriuretic peptide (BNP), C-reactive protein (CRP), nutritional indicators and liver function indicators at ICU admission and 7 days after treatment were compared between the two groups. The time needed for patients to reach EN target, duration of mechanical ventilation, length of ICU stay, and the 28-day mortality were recorded, and complications were observed. Results There was no significant difference in serum BNP, CRP, nutritional indicators or liver function indicators at ICU admission between the two groups. After treatment for 7 days, BNP and CRP in both groups were decreased significantly as compared with those at ICU admission [BNP (ng/L): 592.1±370.9 vs. 2?517.7±1?163.4 in EEN group, 621.9±418.8 vs. 2?251.5±1?006.8 in DEN group;CRP (mg/L): 46.0±19.6 vs. 59.8±22.5 in EEN group, 40.5±18.8 vs. 61.2±24.6 in DEN group, all P < 0.05], pre-albumin (PA) and transferrin (TF) were significantly increased [PA (g/L): 0.18±0.05 v

关 键 词：重度心力衰竭 肠内营养 早期肠内营养 

分 类 号：R541.6[医药卫生—心血管疾病]