鼻肠管联合鼻胃管进行肠内营养对重型胸外伤机械通气患者的疗效分析  

Efficacy analysis of enteral nutrition with nasointestinl tube combined with nasogastric tube on mechanical ventilation patients with severe chest injury

作　　者：王艳 谷仲平 邵琼洁 屈妍 张秋爽 景鹏宇 WANG Yan;GU Zhongping;SHAO Qiongjie;QU Yan;ZHANG Qiushuang;JING Pengyu(the Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院,陕西西安710038

出　　处：《临床医学研究与实践》2022年第24期16-19,共4页Clinical Research and Practice

基　　金：空军军医大学第二附属医院首批“引凤计划”引进对象人才启动费项目(No.2021YFJH016);空军军医大学第二附属医院2021年护理科研立项项目(No.TDHLKY-2021-09)。

摘　　要：目的 探讨鼻肠管联合鼻胃管进行肠内营养(EN)对重型胸外伤机械通气(MV)患者的疗效。方法 选取2019年9月1日至2020年10月31日空军军医大学第二附属医院胸外科重症医学病区收治的90例重型胸外伤MV患者作为研究对象,按照随机数字表法将其分为A组(经鼻胃管管饲EN)、B组(经鼻空肠营养管管饲EN)、C组(经鼻空肠营养管管饲EN联合鼻胃管胃肠减压),各30例。比较三组的治疗效果。结果 治疗第7天,B、C组的血红蛋白(HGB)、血清白蛋白(ALB)水平高于A组,上臂肌围(AMC)长于A组,急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分低于A组,且C组的APACHEⅡ评分低于B组,差异均具有统计学意义(P<0.05);治疗第7天,A、B、C三组的钠离子(Na^(+))、钾离子(K^(+))水平比较,差异无统计学意义(P>0.05)。B、C组的MV时间及住院时间短于A组,且C组的住院时间短于B组,差异均具有统计学意义(P<0.05);B、C两组的MV时间比较,差异无统计学意义(P>0.05)。B、C组的呼吸机相关性肺炎(VAP)、胃潴留、消化道出血及反流误吸发生率均低于A组,且C组的反流误吸发生率低于B组,差异具有统计学意义(P<0.05)。结论 鼻肠管联合鼻胃管进行EN治疗重型胸外伤MV患者的临床效果显著,可有效改善危重症患者的营养状态及预后,降低并发症发生率,值得临床推广。Objective To explore the efficacy of enteral nutrition(EN) with nasointestinl tube combined with nasogastric tube on mechanical ventilation(MV) patients with severe chest injury.Methods A total of 90 patients with severe chest injury admitted in intensive care unit of thoracic surgery department of the Second Affiliated Hospital of Air Force Military Medical University from September 1,2019 to October 31,2020 were selected as the research objects,according to random number table method,the patients were divided into group A(nasoenteric tube feeding EN),group B(nasal jejunal nutrition tube feeding EN) and group C(nasal jejunal nutrition tube feeding EN combined with nasoenteric tube gastrointestinal decompression),with 30 cases in each group.The therapeutic effects of the three groups were compared.Results On the 7th day of treatment,the levels of hemoglobin(HGB) and albumin(ALB) in the group B and C were higher than those in the group A,the arm muscle circumference(AMC) was longer than that in the group A,the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score was lower than that in the group A,and the APACHEⅡ score in the group C was lower than that in the group B,and the differences were statistically significant(P0.05).The MV time and hospital stay in the group B and C were shorter than those in the group A,the hospital stay in the group C was shorter than that in the group B,and the differences were statistically significant(P0.05).The incidences of ventilator-associated pneumonia(VAP),gastric retention,gastrointestinal bleeding and reflux aspiration in the group B and C were lower than those in the group A,the incidence of reflux aspiration in the group C was lower than that in the group B,and the differences were statistically significant( P<0.05).Conclusion EN with nasointestinl tube combined with nasogastric tube in the treatment of MV patients with severe chest injury has a remarkable clinical effect,it can effectively improve the nutritional status and prognosis of critically ill patie

关 键 词：重型胸外伤 肠内营养 鼻肠管 鼻胃管 

分 类 号：R655.1[医药卫生—外科学]