基于喂养流程的脓毒症病人早期肠内营养耐受性的评估与管理  

Evaluation and management of early enteral nutrition tolerance in patients with sepsis based on feeding procedures

作　　者：邸洁 尚昱君 王素梅[2] 谢伟峰[2] 秦贤[2] 曲彦[2] DI Jie;SHANG Yu-jun;WANG Su-mei;XIE Wei-feng;QIN Xian;QU Yan(Qingdao University School of Nursing;Qingdao Municipal Hospital,Qingdao 266071,Shandong,China)

机构地区：[1]青岛大学护理学院 [2]青岛市市立医院,山东青岛266071

出　　处：《肠外与肠内营养》2020年第1期50-55,共6页Parenteral & Enteral Nutrition

摘　　要：目的:探讨基于重症病人肠内营养(EN)喂养流程的早期肠内营养(EEN)耐受性评估与管理对脓毒症病人的影响,为EN实施及管理提供合理依据,以提高病人耐受性及改善疾病预后。方法:抽样选取2018年5月至2019年7月入住山东省青岛市市立医院ICU A病区与B病区的诊断为脓毒症且行EEN病人80例,按入院顺序分为对照组40例与实验组40例,对照组行常规EN治疗,实验组据重症病人EN喂养流程实施EN。结果:EN一周后,实验组前白蛋白(PA)、血红蛋白(Hb)高于对照组,两组间比较差异具有统计学意义(P<0.05)。实验组不耐受例数与不耐受率均低于对照组(P<0.05),实验组目标喂养量达标时间低于对照组[(2.33±2.83)vs(3.93±3.64),P<0.05]。实验组住ICU时间、机械通气时间及28 d病死率与对照组相比,差异均无统计学意义(P>0.05)。结论:脓毒症病人采用基于喂养流程的EEN耐受性评估与管理方案,不仅可提高病人耐受性从而保障EN顺利实施,而且可缩短目标喂养量达标时间,有效地改善病人营养状态,对指导临床治疗具有重要意义。Objective:To investigate the effect of early enteral nutrition tolerance assessment and management on sepsis patients based on enteral nutrition feeding process in critically ill patients,provide a reasonable basis for the implementation and management of enteral nutrition to improve patient tolerance and prognosis of disease.Methods:A total of 80 patients with sepsis and early enteral nutrition were enrolled in the ICU A and B wards of Qingdao City Municipal Hospital of Shandong Province from May 2018 to July 2019.Patients were divided into 40 cases in the control group and 40 cases in the experimental group according to the order of admission.The control group received routine enteral nutrition treatment.The experimental group performed enteral nutrition according to the enteral nutrition feeding process of severe patients.Results:After one week of enteral nutrition,the prealbumin(PA)and hemoglobin(Hb)in the experimental group were higher than those in the control group.The difference between the two groups was statistically significant(P<0.05).The number of intolerance cases and intolerance rate in the experimental group were lower than those in the control group.The target feeding time was lower than the control group[(2.33 d±2.83)d vs(3.93 d±3.64)d,P<0.05],and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in the ICU time,mechanical ventilation time and 28-day mortality between the experimental group and the control group(P>0.05).Conclusion:The early enteral nutrition tolerance assessment and management program based on feeding process in patients with sepsis can not only improve patient tolerance,but also ensure the implementation of enteral nutrition,shorten the target feeding time and effectively improve the nutritional status of patients,and is of great significance for guiding clinical treatment.

关 键 词：脓毒症 早期肠内营养 喂养流程 耐受性管理 

分 类 号：R459.3[医药卫生—治疗学] R459.7[医药卫生—临床医学]