不同时期肠内及肠外营养联合治疗危重患者机械通气40例治疗体会.doc

不同时期肠内及肠外营养联合治疗危重患者机械通气40例治疗体会摘要 目的：分析不同时期肠内与肠外营养联合治疗对危重患者机械通气的影响。方法：40例机械通气的危重患者早期给予肠外营养静脉支持逐渐过渡到肠内营养和常规治疗。观察记录每例患者呼吸机撤机时间、呼吸机相关性肺炎的发生率、ICU住院时间和营养支持并发症发生情况，并监测肾功、肝功及电解质等情况。结果：不同时期肠内与肠外营养联合治疗对危重患者机械通气不仅减少了呼吸机相关性肺炎的发生，使患者早期脱机，减少了患者在ICU住院时间，相对减少了并发症。结论：不同时期肠内与肠外营养联合治疗对机械通气的危重患者，不仅有利于改善全身营养状况、尽早脱机、拔管，减少并发症，改善预后。 关键词 机械通气 危重病 肠内与肠外联合营养支持 Abstract Objective:Analysis of different enteral and parenteral nutrition during the treatment of mechanical ventilation of critically ill patients.Methods:40 cases of early mechanical ventilation in critically ill patients given intravenous parenteral nutrition support for a gradual transition to enteral nutrition and regular treatment.Observed and recorded for each patient ventilator weaning time,ventilator-associated pneumonia incidence,ICU(intensive care unit)length of stay and nutritional support complications,and to monitor renal function,liver function and electrolyte and so on.Results:Different periods of enteral and parenteral nutrition in critically ill patients on combination therapy not only reduces the mechanical ventilation of ventilator-associated pneumonia occurs,so that patients with early off-line,reducing the patients in the ICU length of stay,reduced complications.Conclusion:Different periods of enteral and parenteral nutrition combined treatment of critically ill patients on mechanical ventilation,will not only help improve the general nutritional status,offline as soon as possible,extubation,reduce complications and improve prognosis. Key Words Mechanical ventilation;Critical illness;Enteral and parenteral nutrition support joint 资料与方法 2008～2010年收治危重机械通气(MV)患者40例，APAChE-Ⅱ评分15.2+8.3分，男30例、女10例，平均年龄46.5+18.2岁，原发病为颅脑损伤23例，慢性阻塞性肺病(COPD)5例，支气管哮喘2例，重度充血性心力衰竭2例，胸腹联合伤5例，感染性休克合并急性肾功能衰竭1例，支气管胸膜瘘1例，急性胰腺炎1例。 营养方法：患者自上呼吸机后先经中心静脉置管，给予体积分数为：20%脂肪乳、凡命、水乐维他、安达美、微量元素及葡萄糖溶液配置的营养液300～1000ml/日，过渡到48～72小时后若患者胃肠减压可见正常胃液，逐步给予37～42℃的力士康经鼻饲持续滴入从300ml开始逐渐加量至500～1000ml/日，开始滴速20～40ml/小时，依患者耐受情况增速，24小时后达到60～80ml/小时。同时加用谷氨酰胺颗粒1