重症患者营养风险筛查及肠内肠外营养序贯治疗对临床结局的影响

doi:10.3969/j.issn.1006-6233.2020.06.031

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摘要目的:探讨营养风险筛查及肠内肠外营养贯序治疗对重症患者临床结局的影响。方法:选择2017年12月至2018年12月于我院重症监护室住院的重症患者137例为研究对象,均经营养风险筛查。将其中提示具有营养风险的90例患者按照随机数字法分为两组,各45例。对照组给予全肠外营养治疗,观察组给予肠内肠外营养序贯治疗。于入院时、治疗后14d检测患者白蛋白(ALB)、前白蛋白(PA)和转铁蛋白(TRF)水平。比较患者的总住院费用、重症监护室住院时间及总住院时间。观察并记录患者并发症发生情况。结果:90例具有营养风险的患者NRS 2002平均(5.26±1.02)分,其余47例患者平均NRS2002(2.35±0.68)分,具有显著性差异(t=-17.607,P=0.000)。将具有营养风险的患者随机分为两组,治疗后14d,两组患者ALB、PA和TRF水平均升高,组间比较有显著性差异(P<0.05)。观察组患者总住院费用、重症监护室住院时间及总住院时间均少于对照组(P<0.05)。对照组并发症发生率为55.56%,明显高于观察组的28.89%(χ²=6.559,P=0.010)。感染和应激性血糖升高事件上发生率比较,具有显著性差异(P<0.05)。结论:对于存在营养风险的重症患者进行肠内肠外营养序贯治疗,能改善患者营养状况,恢复胃肠功能,降低并发症的发生率,从而缩短住院时间。

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关键词 ：重症患者, 营养风险筛查, 肠内肠外营养, 序贯治疗, 临床结局

Abstract：Objective: To investigate the effect of nutritional risk screening and sequential treatment of early enteral nutrition combined with parenteral nutrition for critical patients on clinical outcomes. Methods: A total of 137 critical patients admitted to the Intensive Care Unit from December 2017 to December 2018 were enrolled in the study. All of them were screened for nutritional risk. 90 patients with nutritional risk were divided equally into control group, which was treated with total parenteral nutrition, and the observation group, which was given early enteral nutrition combined with parenteral nutrition sequential treatment. The levels of albumin (ALB), prealbumin (PA) and transferrin (TRF) were measured at admission and 14 days after treatment. Total hospitalization cost, ICU stays and hospital stays were compared. The occurrence of complications in patients were observed and recorded. Results: The NRS 2002 average score of 90 patients with nutritional risk was (5.26±1.02), and thereinto, 47 patients had the score of (2.35±0.68). There was a significant difference between the groups (t=-17.607, P=0.000).14 days after treatment, the levels of ALB, PA and TRF were increased in both groups. There was significant difference between the groups (P<0.05).The total hospitalization cost, ICU stays and hospital stays of the observation group were lower than the control group (P<0.05). The complication rate of the control group was 55.56%, which was significantly higher than the observation group (28.89%, χ²=6.559, P=0.010).There was a significant difference in the incidence of infection and stress-induced hyperglycemia (P<0.05). Conclusion: Early enteral nutrition combined with parenteral nutrition sequential treatment for critical patients with nutritional risk can improve the nutritional status, restore gastrointestinal function, reduce the incidence of complications, and shorten the length of hospital stay.

Key words： Critical patients Nutritional risk screening Early enteral nutrition combined with parenteral nutrition Sequential therapy Clinical outcome

基金资助:河北省2017年度医学科学研究重点课题,(编号:20170331)

通讯作者: 董冠楠

引用本文:

王恺, 郑振茹, 李卫敏, 董冠楠. 重症患者营养风险筛查及肠内肠外营养序贯治疗对临床结局的影响[J]. 河北医学, 2020, 26(6): 1020-1023.
WANG Kai, ZHENG Zhenru, et al. The Effect of Nutritional Risk Screening and Sequential Treatment of Enteral Nutrition Combined with Parenteral Nutrition for Critical Patients on Clinical Outcomes. HeBei Med, 2020, 26(6): 1020-1023.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.06.031 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I6/1020

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