【摘要】：目的：探討完全腸內(nèi)營養(yǎng)和輔助腸外營養(yǎng)對膿毒癥患者預(yù)后的影響。方法：選擇收住ICU經(jīng)確診的連續(xù)性膿毒癥患者80例，根據(jù)主治醫(yī)師判斷并結(jié)合家屬意愿給予患者采取不同的營養(yǎng)支持方式，分為完全腸內(nèi)營養(yǎng)組(TEN組，n=52)和輔助腸外營養(yǎng)組（SPN組，n=28)。TEN組入組經(jīng)確診24小時(shí)后待血流動力學(xué)穩(wěn)定經(jīng)鼻空腸營養(yǎng)管啟動腸內(nèi)營養(yǎng)，給予瑞能持續(xù)性泵入，，依據(jù)患者胃腸耐受情況調(diào)整每日輸注量及輸注速度，并于7～10日內(nèi)達(dá)目標(biāo)熱卡及目標(biāo)氮量。SPN組在腸內(nèi)營養(yǎng)支持3日后通過中心靜脈添加腸外營養(yǎng)制劑卡文以滿足目標(biāo)熱卡供給，當(dāng)腸內(nèi)營養(yǎng)支持量滿足80%目標(biāo)熱卡或患者經(jīng)口進(jìn)食時(shí)，停止腸外營養(yǎng)補(bǔ)充。觀察兩組7日病死率、30日病死率、ICU內(nèi)病死率、ICU治療時(shí)間、新發(fā)感染率、機(jī)械通氣時(shí)間以及醫(yī)療成本增加量的差異。結(jié)果：兩組病人7日病死率、30日病死率、ICU內(nèi)病死率、ICU治療時(shí)間、機(jī)械通氣時(shí)間，其差異均無統(tǒng)計(jì)學(xué)意義（P＞0.05）；SPN組醫(yī)療成本明顯增加，人民幣為（5163.32±3733.36）元，顯著高于TEN組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。結(jié)論：輔助腸外營養(yǎng)并未改善膿毒癥患者的預(yù)后。腸內(nèi)營養(yǎng)是膿毒癥患者營養(yǎng)支持的首選。
[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 鹵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.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R459.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 趙允召;膿毒癥性高脂血癥——機(jī)體先天性免疫反應(yīng)的一部分[J];腸外與腸內(nèi)營養(yǎng);2003年02期

2 鄒曰坤;劉于紅;于燕;張志成;;ω-3脂肪酸對膿毒癥病人治療的影響[J];腸外與腸內(nèi)營養(yǎng);2009年04期

3 黎介壽;;臨床營養(yǎng)支持的發(fā)展趨勢[J];腸外與腸內(nèi)營養(yǎng);2010年01期

4 王正國;;當(dāng)前膿毒癥研究的思考[J];解放軍醫(yī)學(xué)雜志;2012年11期

5 劉偉盛;伍方紅;余蘇瓊;;ICU老年危重病患者不同鼻飼方式腸內(nèi)營養(yǎng)相關(guān)性腹瀉發(fā)生率的比較[J];現(xiàn)代醫(yī)藥衛(wèi)生;2009年03期

6 章志丹;;膿毒癥與免疫營養(yǎng)治療[J];中國實(shí)用外科雜志;2010年11期

7 吳肇漢;;感染患者的營養(yǎng)支持[J];中華普通外科學(xué)文獻(xiàn)(電子版);2009年05期

8 張峰;王新穎;李寧;;谷氨酰胺在膿毒癥治療中的作用[J];中國急救醫(yī)學(xué);2007年05期

9 羅良劍;何元明;;嚴(yán)重膿毒癥患者血脂水平變化與預(yù)后的關(guān)系[J];浙江實(shí)用醫(yī)學(xué);2010年02期

10 李多磊;孫立東;趙子瑜;;早期腸內(nèi)營養(yǎng)支持在膿毒癥患者中的應(yīng)用[J];中國誤診學(xué)雜志;2012年07期

本文編號：2466453