不同营养方式对脓毒症患者预后的影响

发布时间：2019-04-26 22:41

【摘要】：目的：探讨完全肠内营养和辅助肠外营养对脓毒症患者预后的影响。方法：选择收住ICU经确诊的连续性脓毒症患者80例，根据主治医师判断并结合家属意愿给予患者采取不同的营养支持方式，分为完全肠内营养组(TEN组，n=52)和辅助肠外营养组（SPN组，n=28)。TEN组入组经确诊24小时后待血流动力学稳定经鼻空肠营养管启动肠内营养，给予瑞能持续性泵入，，依据患者胃肠耐受情况调整每日输注量及输注速度，并于7～10日内达目标热卡及目标氮量。SPN组在肠内营养支持3日后通过中心静脉添加肠外营养制剂卡文以满足目标热卡供给，当肠内营养支持量满足80%目标热卡或患者经口进食时，停止肠外营养补充。观察两组7日病死率、30日病死率、ICU内病死率、ICU治疗时间、新发感染率、机械通气时间以及医疗成本增加量的差异。结果：两组病人7日病死率、30日病死率、ICU内病死率、ICU治疗时间、机械通气时间，其差异均无统计学意义（P＞0.05）；SPN组医疗成本明显增加，人民币为（5163.32±3733.36）元，显著高于TEN组，差异有统计学意义（P＜0.05）。结论：辅助肠外营养并未改善脓毒症患者的预后。肠内营养是脓毒症患者营养支持的首选。
[Abstract]:Objective: to investigate the effect of complete enteral nutrition and supplementary parenteral nutrition on prognosis of sepsis patients. Methods: 80 patients with continuous sepsis diagnosed with ICU were selected and divided into complete enteral nutrition group (TEN group) according to the judgment of the attending physician and the wishes of their families. After 24 hours of diagnosis, the hemodynamic stability of enteral nutrition was initiated through nasojejunal nutrition tube in SPN group (n = 52) and parenteral nutrition group (SPN group, n = 28). TEN group). The daily infusion volume and the infusion speed were adjusted according to the patient's gastrointestinal tolerance. After 3 days of enteral nutrition support, the SPN group was fed with parenteral nutrition agent Calvin through the central vein to meet the target calorie supply, and the target nitrogen content was reached within 7 days after enteral nutrition support, and the parenteral nutrition agent Calvin was added through the central vein after 3 days in SPN group. Stop the parenteral nutrition supplement when the enteral nutrition support reaches 80% of the target calorie or when the patient takes oral food. The difference of 7-day fatality rate, 30-day mortality rate, ICU internal mortality rate, ICU treatment time, new infection rate, mechanical ventilation time and increase of medical cost between the two groups were observed. Results: there was no significant difference between the two groups in 7-day mortality, 30-day mortality, within-ICU mortality, ICU treatment time and mechanical ventilation time (P > 0. 05). The cost of medical treatment in SPN group was (5163.32 卤3733.36) yuan, which was significantly higher than that in TEN group (P < 0.05). Conclusion: assisted parenteral nutrition does not improve the prognosis of sepsis patients. Enteral nutrition is the first choice for nutritional support in sepsis patients.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R459.7

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