早期肠内营养标准化治疗流程管理应用于慢性阻塞性肺疾病急性加重有创机械通气患者的临床效果分析  

Analysis of clinical effects of early enteral nutrition standardized treatment process management on patients with acute exacerbation of chronic obstructive pulmonary disease on invasive mechanical ventilation

作　　者：张锦锋[1] 窦清理 陈涓 梁瑜玲 黄哲梅 Zhang Jinfeng;Dou Qingli;Chen Juan;Liang Yuling;Huang Zhemei(Department of Emergence Medicine,Shenzhen Baoan District People's Hospital(Second Affiliated Hospital of Shenzhen University),Shenzhen 518000,Guangdong,China)

机构地区：[1]深圳市宝安区人民医院(深圳大学附属第二医院)急诊医学科,518000

出　　处：《中华危重病急救医学》2020年第1期67-71,共5页Chinese Critical Care Medicine

基　　金：广东省深圳市科技计划项目(201606057)。

摘　　要：目的探讨早期肠内营养(EN)标准化治疗流程管理对慢性阻塞性肺疾病急性加重(AECOPD)有创机械通气患者通气效果及预后的影响。方法选择2017年1月至2018年12月深圳市宝安区人民医院收治的43例AECOPD有创机械通气患者。依据医院危重患者营养支持治疗持续质量改进项目启动时间,以2018年1月1日为时间节点,将2017年1月1日至12月31日收治的20例患者纳入常规EN组,2018年1月1日至12月31日收治的23例患者纳入早期EN组。早期EN组于患者入重症监护病房(ICU)24 h内血流动力学稳定且不存在EN禁忌证时开始早期经鼻肠管EN,根据EN耐受性评分调整输注速度或添加肠外营养,目标喂养量为104.6~125.5 kJ·kg^-1·d^-1,最终实现完全EN;常规EN组于患者渡过早期应激阶段、生命体征平稳、入ICU 48 h后开始EN,管理流程同早期EN组。比较两组患者撤机时浅快呼吸指数(RSBI)、动脉血pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、剩余碱(BE)和撤机后2 h PaCO2、CO2潴留率等通气指标,以及呼吸机相关性肺炎(VAP)发生率、有创机械通气时间、ICU住院时间、总住院费用、再插管率等重症管理指标。结果早期EN组患者经过早期EN标准化治疗流程管理后,撤机时RSBI明显低于常规EN组(次·min^-1·L^-1:36.68±16.12比52.63±14.81,P<0.05),而pH值、PaO2、PaCO2和BE与常规EN组比较差异均无统计学意义;撤机后2 h PaCO2和CO2潴留率均明显低于常规EN组〔PaCO2(mmHg,1 mmHg=0.133 kPa):52.48±7.62比58.32±8.43,CO2潴留率:(10.25±2.86)%比(18.46±3.21)%,均P<0.05〕。与常规EN组比较,早期EN组VAP发生率〔8.7%(2/23)比15.0%(3/20)〕、有创机械通气时间(h:52.64±14.81比53.78±12.75)、ICU住院时间(d:4.92±1.26比5.24±1.84)、总住院费用(万元:2.09±0.48比2.10±0.69)、再插管率〔13.0%(3/23)比20.0%(4/20)〕均有下降趋势,但差异均无统计学意义(均P>0.05)。结论早期EN标准化治疗流程管理可以Objective To investigate the effect of early enteral nutrition(EN)standardized treatment process management on the ventilation treatment effect and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)on invasive mechanical ventilation.Methods Forty-three patients with AECOPD on invasive mechanical ventilation admitted to Shenzhen Baoan District People's Hospital from January 2017 to December 2018 were enrolled.According to the start time of the continuous quality improvement project of nutritional support treatment for critically ill patients in the hospital,20 patients from January 1st to December 31st in 2017 were enrolled in the routine EN group,and 23 patients from January 1st to December 31st in 2018 were enrolled in the early EN group.In the early EN group,when the patient was hemodynamically stable within 24 hours after intensive care unit(ICU)admission and there was no contraindication for EN,early trans nasal intestinal EN was started,and the infusion rate was adjusted or parenteral nutrition was added according to the EN tolerance score.The target feeding amount was 104.6-125.5 kJ·kg^-1·d^-1,and achieve complete EN.The conventional EN group started EN after patients had experienced the early stress stage,the vital signs were stable,and 48 hours after ICU admission.The management process was the same as the early EN group.The ventilation indicators including rapid shallow breathing index(RSBI),arterial blood pH value,arterial oxygen partial pressure(PaO2),arterial partial pressure of carbon dioxide(PaCO2),and base excess(BE)at weaning,PaCO2,CO2 retention rate at 2 hours after weaning,as well as critical management indicators including the incidence of ventilator-associated pneumonia(VAP),duration of invasive mechanical ventilation,length of ICU stay,total hospitalization cost and re-intubation rate between the two groups were compared.Results After the early EN standardized treatment process management,the RSBI at weaning of the patients in the early EN group w

关 键 词：肠内营养 慢性阻塞性肺疾病 急性加重 临床效果 

分 类 号：R563[医药卫生—呼吸系统]