摘要
背景如何保证呼吸科重症监护室(intensive care unit,ICU)患者肠内营养治疗安全性及有效性成为研究热点.胃残余量为肠内营养重要评估指标,可指导后续干预但近年来临床对胃残余量的评估准确性、科学性存在一定争议.目的探讨腹内压联合24 h胃残余量监测调适的肠内营养方案在呼吸科ICU鼻饲患者中的应用效果.方法选取2019-02/2020-12我院呼吸科ICU鼻饲患者82例,依据随机数字表法分为研究组(n=41)及对照组(n=41).对照组采取常规营养支持,研究组采取腹内压联合24 h胃残余量监测调适的肠内营养方案干预.统计两组治疗情况、干预前后营养状态指标[转铁蛋白(transferrin,TF)、前白蛋白(prealbumin,PA)、白蛋白(albumin,ALB)]水平、T细胞亚群指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平、不良事件发生情况.结果(1)研究组达目标喂养用时、ICU住院时间短于对照组(P<0.05);(2)干预后两组TF、PA、ALB水平较干预前增高(P<0.05),但研究组干预后TF、PA、ALB水平虽略高于对照组,但二者比较无显著差异;(3)两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)干预后水平增高(P<0.05),但研究组干预后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平虽略高于对照组,但二者比较无显著差异;(4)研究组营养达标率较对照组高,营养支持中断发生率较对照组低(P<0.05);(5)研究组腹胀、呕吐的发生率(4.88%)明显低于对照组(21.95%)(P<0.05).但两组吸入性肺炎及腹泻的发生率比较无显著差异.结论腹内压联合24 h胃残余量监测调适的肠内营养方案在呼吸科ICU鼻饲患者中具有较高应用价值,可改善患者机体营养状态及免疫功能,提高生存质量,减少不良事件发生.
BACKGROUND How to ensure the safety and effectiveness of enteral nutrition treatment for patients in the respiratory intensive care unit(ICU)has become a hot research topic.Gastric residual volume is an important evaluation index for enteral nutrition,which can guide follow-up intervention.However,in recent years,there are some controversies on the accuracy and scientificity of the evaluation of gastric residual volume.AIM To explore the application of enteral nutrition adjusted by intra-abdominal pressure combined with 24-h gastric residual monitoring in patients with nasal feeding in the respiratory ICU.METHODS From February 2019 to December 2020,82 patients with nasal feeding in the respiratory ICU of our hospital were selected and divided into a study group(n=41)and a control group(n=41)according to the random number table method.The control group received routine nutritional support,and the study group received enteral nutrition adjusted by intra-abdominal pressure combined with 24-h gastric residual monitoring.Therapeutic effects,the levels of nutritional status indicators[transferrin(TF),prealbumin(PA),and albumin(ALB)]before and after intervention,T cell subset indicators(CD3+,CD4+,and CD4+/CD8+),and the occurrence of adverse events were compared between the two groups.RESULTS Time to target feeding and ICU stay duration were signifi-cantly shorter in the study group than in the control group(P<0.05).After intervention,the levels of TF,PA,and ALB in both groups were significantly higher than those before intervention(P<0.05),but there was no significant difference between the two groups though these indexes in the study group were slightly higher than those of the control group.The levels of CD3+T-cells,CD4+T-cells,and CD4+/CD8+ratio in both groups increased significantly after intervention(P<0.05),but there was no significant difference between the two groups though these indexes in the study group were slightly higher than those of the control group.The compli-ance rate of the study group was significan
作者
沈敏瑾
王黎明
胡春晓
董佳月
Min-Jin Shen;Li-Ming Wang;Chun-Xiao Hu;Jia-Yue Dong(Department of Gastroenterology,Jinhua Central Hospital,Jinhua 321000,Zhejiang Province,China;Gastroenterology Intensive Care Unit,Jinhua Central Hospital,Jinhua 321000,Zhejiang Province,China)
出处
《世界华人消化杂志》
CAS
2024年第6期447-452,共6页
World Chinese Journal of Digestology
关键词
腹内压
胃残留量
肠内营养方案
呼吸重症监护室
鼻饲
Intra-abdominal pressure
Residual gastric volume
Enteral nutrition program
Respiratory intensive care unit
Nasal feeding
