【摘要】：目的：探討完全腸內(nèi)營(yíng)養(yǎng)和輔助腸外營(yíng)養(yǎng)對(duì)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(yíng)養(yǎng)支持方式，分為完全腸內(nèi)營(yíng)養(yǎng)組(TEN組，n=52)和輔助腸外營(yíng)養(yǎng)組（SPN組，n=28)。TEN組入組經(jīng)確診24小時(shí)后待血流動(dòng)力學(xué)穩(wěn)定經(jīng)鼻空腸營(yíng)養(yǎng)管啟動(dòng)腸內(nèi)營(yíng)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(yíng)養(yǎng)支持3日后通過(guò)中心靜脈添加腸外營(yíng)養(yǎng)制劑卡文以滿足目標(biāo)熱卡供給，當(dāng)腸內(nèi)營(yíng)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(yíng)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(wú)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(yíng)養(yǎng)并未改善膿毒癥患者的預(yù)后。腸內(nèi)營(yíng)養(yǎng)是膿毒癥患者營(yíng)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(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R459.7

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