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目的:观察以短肽、短肽与整蛋白混合、整蛋白配方序贯调整的肠内营养(EN)方案对老年危重症病人的营养支持效果。方法:将94例老年危重症病人随机分为两组,即对照组45例,采用整蛋白配方,浓度、剂量、滴速均按常规方法逐渐调整增加;研究组49例,第1、2天给予短肽配方百普素,3 d后给予短肽与整蛋白混合液(百普素与能全力),持续几天后逐渐过渡至完全整蛋白配方。两组必要时均以肠外营养(PN)补充以达到目标供给量。比较两组病人治疗前和治疗后第7、14天胃肠道并发症的发生率、营养状况、C-反应蛋白(CRP)、APACHEⅡ评分、胃肠功能评分以及14~28 d内的病死率等。结果:研究组病人胃肠道并发症的发生率较对照组显著降低。治疗14 d时,两组病人的前清蛋白、转铁蛋白、CRP、APACHEⅡ评分、胃肠功能评分等均较治疗前显著改善。研究组病人治疗7 d时前清蛋白较对照组显著升高,14 d时差异更加明显。研究组病人治疗14 d时转铁蛋白较对照组明显升高,治疗7 d时CRP较对照组明显下降,治疗14 d时差异更加明显。研究组病人治疗14 d时,APACHEⅡ评分、胃肠功能评分均较对照组显著降低,病死率较对照组有所下降。结论:以短肽、短肽与整蛋白混合、整蛋白配方序贯调整的EN方案,能显著地改善ICU老年危重症病人的营养状况和胃肠功能,有利于改善预后。
OBJECTIVE: To observe the effect of enteral nutrition (EN) regimen with short peptide, short peptide and whole protein, and sequential adjustment of whole protein formula on nutritional support for geriatric critically ill patients. Methods: Ninety-four elderly critically ill patients were randomly divided into two groups (control group, 45 cases). The whole protein formula was used. The concentration, dosage and drip rate were gradually adjusted and increased according to the routine method. Given small peptide formula berberine, given 3 days after the short peptide mixture with the whole protein (berbudline and can be full), gradually transition to a few days after the complete whole protein formula. Both groups were supplemented with parenteral nutrition (PN) to achieve the target supply if necessary. The incidence of gastrointestinal complications, nutritional status, C-reactive protein (CRP), APACHEⅡscore, gastrointestinal function score and mortality within 14-28 days before and after treatment were compared between the two groups Wait. Results: The incidence of gastrointestinal complications in study group was significantly lower than that in control group. On the 14th day of treatment, the serum albumin, transferrin, CRP, APACHEⅡscore and gastrointestinal function scores of the two groups were significantly improved compared with those before treatment. Pretreatment albumin in study group patients was significantly higher than the control group on the 7th day, and the difference was more obvious on the 14th day. The transferrin in study group was significantly higher than that in control group on the 14th day of treatment, and the CRP in the study group was significantly lower than that in the control group on the 7th day after treatment, and the difference was more obvious on the 14th day. On the 14th day after treatment, APACHEⅡscore and gastrointestinal function scores of the study group patients were significantly lower than those of the control group, and the mortality was lower than that of the control group. CONCLUSION: The EN regimen with short peptides, short peptides and whole proteins, and sequential adjustment of the whole protein formula can significantly improve the nutritional status and gastrointestinal function of elderly critically ill patients in the ICU and improve prognosis.