呼吸机相关性肺炎患者肠内营养与肠外营养支持疗效比较
Effect of enteral nutrition versus parenteral nutrition on outcomes of ventilator-associated pneumonia

目的:探讨肠内营养(EN)支持与肠外营养(PN)支持对呼吸机相关性肺炎(VAP)患者预后的影响。方法:100例VAP患者分EN组(50例,经鼻胃管给予肠内营养混悬液)和PN组(50例,给予静脉营养)。观测两组患者营养指标(入院第1、7、14天血清白蛋白、前白蛋白、血红蛋白水平)和临床结局指标(营养达标率、达标所需时间、机械通气时间、ICU入住时间、住院时间、感染性休克发生率及脱机成功率)的差异。结果:入组后EN组与PN组患者血清白蛋白、前白蛋白、血红蛋白水平随时间推移变化不大(F时间= 0.453、0.132、0.583,P>0.05),EN组血清白蛋白、前白蛋白水平均高于PN组(F组间=15.564、23.340,P<0.05)。EN组营养达标率高于PN组(χ2=10.391,P<0.001),达标所需时间短于PN组(t=4.010,P=0.003),机械通气时间短于PN组(t=3.121,P=0.007)。两组ICU入住时间、住院时间、感染性休克发生率及脱机成功率差异无统计学意义(P>0.05)。结论:VAP患者行EN支持可更快更好地改善营养状况,并缩短机械通气时间。
Aim: To compare the effect of enteral nutrition versus parenteral nutrition on outcomes of ventilator-associated pneumonia(VAP).Methods: A total of 100 VAP patients were allocated into enteral nutrition group(EN group, 50 patients)and parenteral nutrition group(PN group, 50 patients). The EN group was treated with enteral nutritional suspension, and the PN group was treated with intravenous nutrition. The nutritive indexes including albumin, prealbumin, hemoglobin at 1, 7, 14 days and clinical outcomes including the rate and the time of reaching the target state of nuitrition, time of mechanical ventilation, ICU stay time, hospital stay time, the incidence of septic shock and rate of free from respirator were recorded.Results: The serum albumin, prealbumin, and hemoglobin levels of the two groups did not change much(Ftime=0.453, 0.132, 0.583,P>0.05). The level of albumin and prealbumin of EN group were higher than those of PN group(Fgroup=15.564, 23.340,P<0.05). The rate of reaching the target state of nutrition for EN group was superior to PN group(χ2=10.391,P<0.001), also, the time of reaching the standard and mechanical ventilation were shorter in EN group(t=4.010,3.121,P<0.05). But there was no difference between the two groups in the ICU stay time, hospital stay time, the incidence of septic shock or rate of free from respirator(P>0.05).Conclusion: For VAP patients, the way of EN could improve the nutrition state more faster and better, and decrease the duration of mechanical ventilation