不同营养方式对呼吸科老年重症患者呼吸肌力及临床预后的影响

目的 比较不同营养方式对呼吸科老年重症患者呼吸肌力和临床结局的影响.方法 采用随机数字表法,将147例呼吸科老年重症患者按入院先后顺序随机分为肠内(EN)肠外(PN)混合营养组,EN组和PN组,每组49例,观察营养支持前后患者能量代谢指标和呼吸肌力的变化情况及短期结局.结果 营养支持后第7天,各组患者的血浆白蛋白(ALB)、血红蛋白(Hb)、肌酐(Cr)水平和氮平衡均较营养支持前明显升高(P均＜0.01),血尿素氮(BUN)水平较营养支持前明显下降(P＜0.01);混合营养组ALB、Hb、Cr和氮平衡升高幅度均明显高于EN组和PN组(P＜0.05或P＜0.01),BUN下降幅度明显高于EN组(P＜0.05).混合营养组(P=0.021)和EN组(P=0.011)的最大吸气压水平明显高于营养支持前,混合营养组的气道阻断压水平明显低于营养支持前(P=0.025).PN组患者感染性并发症及非感染性并发症发生率明显高于EN组 (P=0.002,P=0.017)和混合营养组(P=0.005,P=0.004),EN组患者的胃潴留发生率明显高于PN组(P=0.035).混合营养组患者的脱机时间、呼吸重症监护病房停留时间、住院时间与20 d死亡率均明显小于EN组和PN组(P均＜0.05).结论 EN与PN联用改善呼吸科老年重症患者营养状况和呼吸肌力的效果明显优于单用EN和PN,其短期临床结局也好于单用EN和PN.

Abstract：

Objective To compare the influences of different routes of nutrition on the outcome and respiratory muscle strength of elderly patients in respiratory intensive care unit (RICU). Methods Totally 147 elderly patients in RICU were equally randomized into combined nutrition group ( combinination of parenteral nutrition and enteral nutrition), total enteral nutrition (EN) group, and total parenteral nutrition (PN) group. The changes of energy metabolism, respiratory muscle strength, and short-term outcome were observed or determined.Results Plasma albumin (ALB), hemoglobin (Hb), creatinine (Cr) levels, and nitrogen balance significantly increased in all group 7 days later ( all P ＜ 0. 01 ), while blood urea nitrogen (BUN) significantly decreased ( P ＜0.01 ). The increase of ALB, Hb, Cr levels, and nitrogen balance were significantly more remarkable than that in EN group and PN group (P＜0.05 or P＜0.01). The decrease of BUN level in the combined nutrition group was significantly more remarkable than that in EN group ( P ＜ 0. 05 ). After nutritional support, the maximum inspiratory pressure in the combined nutrition group (P =0. 021 ) and EN group (P = 0. 011 ) became significantly higher, and occlusion pressure at 0.1 second inspiration level in the combined nutrition group became significantly lower ( P =0. 025). The incidences of infectious and non-infectious complications in PN group were significantly higher than those in EN group (P = 0. 002 and 0. 017, respectively) and combined nutrition group ( P = 0. 005 and 0. 004, respectively). Gastric retention was more common in EN group than that in PN group ( P = 0. 035). The weaning time,length of RICU stay, length of hospital stay and 20-day-mortality were significantly decreased in the combined nutrition group than those in the other two groups ( all P ＜ 0. 05 ). Conclusion The effectiveness of the combined application of PN and EN is superior to PN or EN alone in improving nutritional status and respiratory muscle strength as well as in improving the short-term outcome in elderly patients in RICU..

Influence of different routes of nutrition on the respiratory muscle strength and prognosis of elderly patients in respiratory intensive care unit

Objective To compare the influences of different routes of nutrition on the outcome and respiratory muscle strength of elderly patients in respiratory intensive care unit (RICU). Methods Totally 147 elderly patients in RICU were equally randomized into combined nutrition group ( combinination of parenteral nutrition and enteral nutrition), total enteral nutrition (EN) group, and total parenteral nutrition (PN) group. The changes of energy metabolism, respiratory muscle strength, and short-term outcome were observed or determined.Results Plasma albumin (ALB), hemoglobin (Hb), creatinine (Cr) levels, and nitrogen balance significantly increased in all group 7 days later ( all P ＜ 0. 01 ), while blood urea nitrogen (BUN) significantly decreased ( P ＜0.01 ). The increase of ALB, Hb, Cr levels, and nitrogen balance were significantly more remarkable than that in EN group and PN group (P＜0.05 or P＜0.01). The decrease of BUN level in the combined nutrition group was significantly more remarkable than that in EN group ( P ＜ 0. 05 ). After nutritional support, the maximum inspiratory pressure in the combined nutrition group (P =0. 021 ) and EN group (P = 0. 011 ) became significantly higher, and occlusion pressure at 0.1 second inspiration level in the combined nutrition group became significantly lower ( P =0. 025). The incidences of infectious and non-infectious complications in PN group were significantly higher than those in EN group (P = 0. 002 and 0. 017, respectively) and combined nutrition group ( P = 0. 005 and 0. 004, respectively). Gastric retention was more common in EN group than that in PN group ( P = 0. 035). The weaning time,length of RICU stay, length of hospital stay and 20-day-mortality were significantly decreased in the combined nutrition group than those in the other two groups ( all P ＜ 0. 05 ). Conclusion The effectiveness of the combined application of PN and EN is superior to PN or EN alone in improving nutritional status and respiratory muscle strength as well as in improving the short-term outcome in elderly patients in RICU..