10例有创机械通气新型冠状病毒肺炎危重型患者营养干预实践总结  

Nutrition intervention for 10 coronavirus disease 2019 patients with severe invasive ventilation

作　　者：王晓蓉[1] 陈黎黎 钱松赞 张宸 黄跃跃[1] 朱椰凡[1] 潘景业[1] Wang Xiaorong;Chen Lili;Qian Songzan;Zhang Chen;Huang Yueyue;Zhu Yefan;Pan Jingye(Department of Critical Care Medicine,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou,325000,Zhejiang,China)

机构地区：[1]温州医科大学附属第一医院重症医学科,浙江温州325000

出　　处：《中国中西医结合急救杂志》2021年第6期685-689,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：温州市科技局项目(S20190016);浙江省教育厅一般项目(Y202045534)。

摘　　要：目的分析合并急性呼吸功能衰竭新型冠状病毒肺炎(新冠肺炎)危重型患者的肠内营养(EN)治疗方案并提出建议,以期为新冠肺炎危重型患者的EN治疗提供参考。方法纳入2020年1月26日至2月18日温州医科大学附属第一医院重症隔离病房收治的10例新冠肺炎危重型机械通气患者,入科后及时留置鼻空肠管行早期个体化EN治疗及全程药学监测。收集患者入重症隔离病房时和留置鼻空肠管7 d后的序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、营养风险评分(NUTRIC)、血白蛋白(ALB)等营养指标及每日EN的总能量、蛋白量及胃肠道并发症情况。比较各指标前后的变化,分析其可能原因。结果新冠肺炎危重型患者入院时的SOFA、APACHEⅡ、NUTRIC评分均较高,ALB、淋巴细胞计数(LYM)、血磷指标均低下,白细胞介素-6(IL-6)不同程度升高。EN支持7 d后,SOFA、APACHEⅡ、NUTRIC评分与入院时比较差异均无统计学意义〔SOFA评分(分):4.1±3.48比4.2±2.78,APACHEⅡ评分(分):10.8±4.29比10.4±4.25,NUTRIC评分(分):2.3±1.89比2.3±1.57,均P>0.05〕;血ALB较入院时明显升高(g/L:34.4±2.10比30.13±3.88,P<0.05),LYM、血磷、IL-6与入院时比较差异无统计学意义〔LYM(×10^(9)/L):0.09±0.04比0.28±0.37,血磷(mmol/L):0.98±0.28比0.83±0.22,IL-6(ng/L):61.41±76.38比74.49±99.93,均P>0.05〕;每日能量摄入量和蛋白摄入量较入院时明显提高〔能量摄入量(kcal·kg^(-1)·d^(-1)):18.29±7.81比7.20±2.19,蛋白摄入(g·kg^(-1)·d^(-1)):1.14±0.24比0.29±0.61,均P<0.05〕。结论新冠肺炎危重型患者往往合并器官功能不全、营养风险高,需要结合病情进行营养风险评估,早期不能进食患者留置鼻空肠管予以个体化的EN支持方式值得推荐;具有营养评估经验的重症医学医师可进行EN治疗,帮助患者更快达到低热量目标能量和蛋白需求量的75%以上。血ALB、血磷及LYM低下提示病情危Objective To analyze the enteral nutrition(EN)treatment of the coronavirus disease 2019(COVID-19)patients with severe acute respiratory failure,and provide reference for EN treatment of critical and severe COVID-19 patients.Methods Ten critical and severe COVID-19 patients with mechanical ventilation admitted to the isolation intensive care unit of the First Affiliated Hospital of Wenzhou Medical University from January 26 to February 18,2020 were included.After entering the department,they were timely indwelling nasojejunal tube for early individualized enteral nutrition treatment and whole-course pharmaceutical monitoring.The changes of sequential organ failure score(SOFA),acute physiology and chronic health status scoreⅡ(APACHEⅡ),nutritional risk factor(NUTRIC)scores,albumin(ALB)and other nutritional indexes were collected retrospectively when the patients were admitted to isolation intensive care unit and 7 days after indwelling nasojejunal tube.At the same time,the total energy,protein content and gastrointestinal complications of daily enteral nutrition were collected.Results The scores of SOFA,APACHEⅡand NUTRIC of critical and severe COVID-19 patients were higher at admission,while the indexes of ALB,lymphocyte(LYM)and blood phosphorus were lower,while interleukin-6(IL-6)increased in different degrees.After 7 days of EN support,there were no significant differences in SOFA,APACHEⅡand NUTRIC scores compared with those at admission(SOFA score:4.1±3.48 vs.4.2±2.78,APACHEⅡscore:10.8±4.29 vs.10.4±4.25,NUTRIC score:2.3±1.89 vs.2.3±1.57,all P>0.05);the serum ALB were higher than before(g/L:34.4±2.10 vs.30.13±3.88,P<0.05),there were no significant differences in LYM,blood phosphorus and IL-6 compared with those at admission[LYM(×10^(9)/L):0.09±0.04 vs.0.28±0.37,blood phosphorus(mmol/L):0.98±0.28 vs.0.83±0.22,IL-6(ng/L):61.41±76.38 vs.74.49±99.93,all P>0.05],the average energy and protein intake were increased than before[average energy intake(kcal·kg^(-1)·d^(-1)):18.29±7.81 vs.7.20±2.1

关 键 词：新型冠状病毒感染 重症肺炎 鼻空肠管 营养风险筛查 急性器官损伤 肠内营养 

分 类 号：R47[医药卫生—护理学]