摘要
目的探索俯卧位机械通气患者早期肠内营养(Enteral Nutrition,EN)的策略。方法共纳入72例患者,采用随机数字表法分为对照组34例,试验组38例。所有患者在气管内机械通气开始后24 h内开始肠内营养。如果PaO2/FiO2<150(FiO2<0.6和PEEP<10 cmH2O)保持4 h,则开始转为俯卧位。对照组采用常规的方法通过鼻胃管输注肠内营养液,试验组根据每天肠内营养剂总量,计算平均输注速度,增加营养液输送速率。在开始肠内营养时即给予红霉素、床头抬高45°的方法。比较两组患者每日肠内营养液摄入量、胃残留量、呼吸机相关性肺炎发生率、对EN的不耐受患者(呕吐和/或胃残留量>250 mL)发生率。结果与对照组相比,试验组每日肠内营养液摄入量从第2天开始就有显著增加,差异具有统计学意义(P<0.05);从第3天开始,试验组患者的每日胃残留量降低,与对照组相比差异具有统计学意义(P<0.05);对EN不耐受对照组发生24例(70.5%),试验组17例(44.7%),组间比较差异有统计学意义(P<0.026);对照组10例(29.4%)患者发生呼吸机相关性肺炎,试验组9例(23.6%),两组发生呼吸机相关性肺炎例数差异无统计学意义(P>0.05)。结论对重症俯卧位机械通气患者采用包括俯卧位头部抬高,增加营养液输送速率和预防性使用红霉素的策略,可以在不增加呼吸机相关性肺炎发生例数的情况下提高患者对EN的耐受性,输送足量的营养液。
Objective To explore the strategy of early Enteral Nutrition(EN) in patients with mechanical ventilation in prone position. Methods A total of 72 patients were included, which were divided into control group(34 cases) and experimental group(38 cases) by random number table. EN was initiated in all patients within 24 hrs after the start of mechanical ventilation in the trachea. After keeping PaO2/FiO2 at <150(FiO2<0.6 and PEEP<10 cmH2O) for 4 hrs, the patient shifted to prone position. The control group was routinely transfused with enteral nutrient solution via nasogastric tube. The average infusion speed of the experimental group was calculated based on the daily total amount of enteral nutrient, so as to increase the delivery rate of the nutrient solution. Erythromycin was administered at the beginning of enteral nutrition and the head was raised by 45°. The daily enteral nutrient intake, gastric residue, incidence of ventilator-associated pneumonia, and incidence of EN intolerance(vomiting and/or gastric residue >250 mL) were compared between the two groups. Results Compared with the control group, the daily intake of enteral nutrient solution in the experimental group was statistically significant from the second day(P<0.05). From day 3, the decrease of daily gastric residue in the experimental group was statistically significant(P<0.05). EN intolerance occurred in 24 cases(70.5%) in the control group and 17 cases(44.7%) in the experimental group, and the difference between the two groups was statistically significant(P<0.026). In the control group, 10 patients(29.4%) had ventilator-related pneumonia, and in the experimental group, 9 patients(23.6%) had ventilator-related pneumonia. There was no significant difference in the number of ventilator-related pneumonia between the two groups(P>0.05). Conclusion Nursing strategies including elevation of the head in the prone position, increasing the rate of nutrient solution delivery, and prophylactic use of erythromycin can improve patients′ tolerance to EN and
作者
刘红
刘红娟
刘巧
刘丹
LIU Hong;LIU Hongjuan;LIU Qiao;LIU Dan(Department of Critical Care, Xi'an No.1 Hospital, Xi'an 710000, China;The Fourth Ward of Cardiovascular, Xi'an No.1 Hospital, Xi'an 710000, China;Department of Orthopaedic, Xi'an No.1 Hospital, Xi'an 710000, China)
出处
《新疆医科大学学报》
CAS
2019年第10期1315-1318,1323,共5页
Journal of Xinjiang Medical University
基金
西安市科技计划项目(2016SF1316)
关键词
肠内营养
机械通气
呼吸机相关性肺炎
enteral nutrition
mechanical ventilation
ventilator related pneumonia
nursing strategy
