摘要目的 比较不同肠内营养供给方式对老年重症肺炎患者营养支持的疗效.方法 选择2015年6月至2018年6月同济大学附属东方医院急诊监护室收治的符合重症肺炎诊断标准,平均年龄大于65岁的老年重症肺炎患者86例,按随机数字分为对照组和观察组,每组各43例.两组患者均予留置鼻空肠营养管,观察组给予持续加热推泵输注肠内营养乳剂,对照组采用顿服瑞能营养液.治疗10d后,观察并比较两组患者营养水平、免疫指标、炎症指标、氧合指标的变化,同时进行胃肠道功能障碍(gastrointestinal dysfunction and failure,GIDF)评分以及序贯器官衰竭(sequential organ failure assessment,SOFA)评分,记录临床转归(机械通气时间和治疗有效率).采用SPSS 20.0进行统计分析,同组治疗前后比较采用自身配对t检验;计数资料组间比较采用x2检验.结果 两组患者基线资料差异无统计学意义(P＞0.05),具有可比性.与对照组相比,观察组患者治疗10d后白蛋白[(31.22±2.36) g/L]及前白蛋白[(0.29±0.24) g/L]均有升高(P=0.015和P=0.023),免疫指标水平改善[IgG(13.24±0.70) g/L,P=0.020;IgM(1.43±0.19)g/L,P=0.011;CD4+/CD8+ 1.55±0.49,P=0.043],炎症指标有所下降[IL-6(312.54±42.53) pg/mL,P=0.031;PCT(1.56±0.81) ng/mL,P=0.017],血气氧合指数改善[PaO2/FiO2(315.58±20.37)mmHg,P=0.019].GIDF评分(10.6±1.2)、SOFA评分(8.5±1.7)均低于对照组(P=0.041和P=0.038).临床转归情况提示观察组机械通气时间明显减少[(6.01±1.48)d vs(8.12±1.17)d,P=0.039],治疗总有效率优于对照组(67.44％ vs 41.86％,P=0.027).结论 老年重症肺炎患者的肠内营养支持中应用持续加热推泵的输注方式,能够有效改善患者的营养状况,减少胃肠道功能障碍的发生率,维持脏器功能稳定,提高临床治疗有效率.

abstractsObjective To compare the effect of different enteral nutritional support methods in elderly patients with severe pneumonia.Methods Elderly patients (average age over 65 years) with severe pneumonia admitted to our hospital from June 2015 to June 2018 were selected as the study subjects,and 86 patients finally completed the study.The patients were randomly divided into the control group and observation group with 43 patients in each group,and nasojejunal tubes were placed for patients in both groups.Patients in the observation group were fed with enteral nutrition emulsion through continuously-heated nutritional pump,while patients in the control group was meal served with enteral nutrition emulsion.Changes in blood biochemical parameters,immune indexes,inflammation indexes,oxygenation indexes,the GIDF and SOFA scores as well as curative effect (mechanical ventilation time and effective rate of treatment) were monitored and compared before and after 10 days of nutritional support treatment.SPSS 20.0 statistical software package was used for data analysis,and self paired t-test was used for comparison before and after intervention in the same group,x2 test was used in comparison between different groups,and the counting data was expressed as the rate (n,％).Results There was no significant difference in baseline data between patients in the two groups (P＞0.05).After ten days of intervention,compared with the control group,the levels of serum albumin and prealbumin in the observation group were higher [(31.22±2.36) g/L and (0.29±0.24) g/L,P=0.015 and P=0.023],the immune indexes were higher [IgG (13.24±0.70) g/L,P=0.020;IgM (1.43±0.19) g/L,P=0.011;CD4+/CD8+ 1.55±0.49,P=0.043],the inflammation indexes were lower [IL-6 (312.54±42.53) pg/mL,P=0.031;PCT (1.56±0.81) ng/mL,P=0.017],the oxygenation indexes were better [PaO2/FiO2 (315.58±20.37) mmHg,P=0.019],and the GIDF and SOFA scores were significantly lower[(10.6±l.2) and (8.5±1.7),P=0.041 and P=0.038].The clinical outcome showed that the mechanical ventilation time in the observation group was significantly shorter [(6.01±1.48) d vs (8.12 ± 1.17)d,P=0.039],and the total effective rate of treatment was better than the control group (67.44％ vs 41.86％,P=0.027).Conclusions Enteral nutrition support through continuously-heated nutritional pump can improve the nutritional status of elderly patients with severe pneumonia,reduce the incidence of gastrointestinal dysfunction,maintain stable organ fuction,thus resulting in better prognosis in elderly patients with severe pneumonia.