摘要目的 探讨早期肠内营养达标与否,对不同疾病严重程度重症患者住院时间、医疗费用以及生存率等的影响.方法 2008年1月1日至2009年6月30日入住苏州大学附属第二医院ICU的患者,满足以下标准进入本研究:(1)年龄≥18岁;(2)住院时间≥72 h;(3)入ICU 48 h内予以肠内营养.依据第3天肠内供给能量是否达到目标供给量62.7 kJ/(kg·d)的60%,分为达标组和未达标组;再根据APACHEⅡ评分将每组患者分为＜15分、15～25分和＞25分3个亚组,并比较患者不同疾病严重程度的住院时间、医疗费用及死亡率.结果 共有192例重症患者进入本研究,62例患者的早期肠内营养达标,而其余的130例患者未达标.对于APACHEⅡ评分＜15分的患者,达标组患者的总住院时间明显低于未达标组(P＜0.01);对于APACHEⅡ评分15至25分的患者,达标组患者除总住院时间(P＜0.01)外,ICU住院时间(P＜0.01)、医疗费用(P＜0.01)及死亡率(P＜0.05)均明显低于未达标组;当APACHEⅡ评分＞25分时,达标组患者医疗费用明显降低(P＜0.01).结论 早期肠内营养达标能改善重症患者的预后,并且其临床治疗价值随疾病严重程度的不同而异.

abstractsObjective To determine the effects of the early enteric nutrition (EEN) up to scratch on the outcomes of the critical care patients with different degrees of severity of illness. Method There were 192 critically ill patients eligible for enrollment for study during the past 18 months in our ICU. They were classified by using APACHE Ⅱ scores. The aim of this retrospective analysis of the early enteric nutrition was to see if the enteric nufore, the patients were divided into two groups: up to scratch group and not up to scratch group. According to APACHE Ⅱ scores, the patients of each group were further divided into three sub-groups in terms of scores below 15, between15 and 25, and above 25, respectively. Results There were 62 patients in the group of EEN up to scratch, and 130 patients' EEN did not up to scratch. When the scores of APACHE Ⅱ were below 15, the length of hospital stay (LOS) was significantly shorter in group of EEN up to scratch in comparison with that of EEN not up to scratch (t = 6.453, P = 0.000). When the scores of APACHE Ⅱ were between15 and 25, the LOS in ICU (t = 3.966, P = 0.000), in hospital (t = 8.165,P = 0.000), The cost of medical care (t = 4.812,P= 0.000) and the mortality (x2 = 5.421,P = 0.038) were all significantly less in patients with EEN up to scratch. However, when the scores of APACHE Ⅱ were above 25, only the cost of medical care ( t = 7.364, P = 0.000) was significantly lower in patients of EEN up to scratch than that of EEN not up to scratch. Conclusions The EEN up to scratch can significantly improve the outcomes of critical patients and the clinical value of EEN up to scratch depends on the severity of illness.