摘要目的 探讨重症患者肠内营养喂养流程在ICU中的应用效果,以减少并发症的发生及促进患者康复.方法 制订肠内营养喂养流程,选取2018年1-10月ICU收治的184例重症患者作为研究对象,1-5月入科的90例患者为对照组,6-10月入科的94例患者为观察组.对照组患者采用常规营养支持及护理,观察组患者实施重症肠内营养喂养流程,对2组患者营养状况指标、免疫指标、胃肠功能失调发生率、院内感染并发症、患者结局指标进行比较.结果 治疗1周后观察组的营养状况指标血红蛋白、血清总蛋白、血清白蛋白分别为(119.73 ± 9.96)、(58.88 ± 2.65)、(29.09 ± 1.42)g/L,免疫指标IgA、IgG、IgM分别为(2.56 ± 0.10)、(2.98 ± 0.36)、(1.65 ± 0.15)g/L,对照组分别为(108.02 ± 9.21)、(51.90 ± 2.74)、(27.80 ± 1.59)、(2.09 ± 0.18)、(2.01 ± 0.24)、(1.41 ± 0.13)g/L, 2组比较差异有统计学意义(t=5.81~22.48,P＜0.01).观察组胃肠功能失调(胃潴留、腹泻)发生率分别为11.70%(11/94)、8.51%(8/94),院内感染发生率(呼吸机相关性肺炎、导管相关血流感染、尿管相关尿路感染)分别为6.12‰(5/817)、1.53‰(1/650)、0,患者结局指标(营养达标时间、ICU住院时间、病死率)分别为(6.12 ± 1.03)d、(10.98 ± 2.03)d、13.82%(13/94),均低于对照组的23.33%(21/90)、20.00%(18/90)、13.06‰(11/842)、11.28‰(8/709)、2.88‰(2/694)、(7.98 ± 1.54)d、(12.21 ± 1.87)d、26.67%(24/90),2组比较差异有统计学意义(χ2=4.33~8.22,t=6.19、2.26,P＜0.05).结论重症患者肠内营养喂养流程可有效减轻患者肠内营养并发症,使患者早期获得有效营养.

abstractsObjective To investigate the effect of enteral nutrition feeding procedure in ICU in severe patients in order to reduce complications and promote rehabilitation of patients. Methods A total of 184 severe patients admitted to ICU from January to October 2018 were selected as the subjects of the study. 90 patients admitted to the family from January to May were the control group, and 94 patients admitted to the family from June to October were the observation group. The control group adopted routine nutritional support and nursing, and the observation group carried out intensive enteral nutrition feeding process. The nutritional status, immunity, gastrointestinal dysfunction, complications of nosocomial infection and outcome of patients in two groups were compared between the two groups. Results The nutritional indicators of hemoglobin, serum total protein and serum albumin after a week of treatment were (119.73 ± 9.96), (58.88 ± 2.65), (29.09 ± 1.42) g/L, immunization indicators IgA, IgG, IgM were (2.56± 0.10), (2.98 ± 0.36), (1.65 ± 0.15) g/L in the observation group. The control groups were (108.02 ± 9.21), (51.90 ± 2.74), (27.80 ± 1.59), (2.09 ± 0.18), (2.01 ± 0.24), (1.41 ± 0.13)g/L, the difference between the two groups was statistically significant (t=5.81-22.48, P＜0.01). The incidence of gastrointestinal dysfunction (gastric retention, diarrhea) in the observation group were 11.70%(11/94), 8.51%(8/94), the incidence of nosocomial infections (ventilator associated pneumonia, catheter related blood stream infection, catheter-associated urinary tract infections) were 6.12‰(5/817), 1.53‰(1/650), 0, the outcome indicators of patients (nutritional standard time, ICU hospitalization time, and mortality rate) were (6.12 ± 1.03) d, (10.98±2.03) d, 13.82%(13/94), all were lower than the control group′s 23.33%(21/90), 20.00%(18/90), 13.06‰(11/842), 11.28‰(8/709), 2.88‰(2/694), (7.98 ± 1.54) d, (12.21 ± 1.87) d, 26.67 %(24/90), the difference between the two groups was statistically significant (χ2=4.33-8.22, t =6.19, 2.26, P＜0.05). Conclusions The procedure of enteral nutrition feeding in patients with severe illness can effectively reduce enteral nutrition complications and enable patients to obtain effective nutrition early.