【作者】 李晓丽；

【导师】 罗小星；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2009， 硕士

【摘要】 背景机械通气已广泛应用于危重病医学等多个临床领域,是抢救的重要手段之一。机械通气患者营养不良发生率很高,已经成为ICU中常见的潜在致死性并发症,也是导致呼吸机依赖的主要原因之一。机械通气患者的早期多以高代谢反应为特征,临床上表现为分解代谢增强,机体内存蛋白质和脂类大量消耗,呼吸肌萎缩,呼吸无力,呼吸机依赖。因此如何对危重病中机械通气患者进行营养支持至关重要。目的本研究探讨了中药营养剂(四君子汤)对危重病机械通气患者营养支持临床的效果,通过前瞻性的随机对照研究比较添加四君子汤的肠内营养(EN)支持前后各种营养指标的变化、呼吸功能的改变及不良反应,为中医药在危重病营养支持领域的应用作了一些尝试。方法选取2007年4月至2009年2月入住我院ICU机械通气患者50例,随机分为治疗组和对照组各25例,收集一般临床资料。对照组仅给予常规肠内营养支持方案(能全力500ml),治疗组予以常规营养支持(能全力500ml)加四君子汤200ml。均于支持前和营养支持后第十日监测营养指标如血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)、血红蛋白(Hb)、胆固醇(TC)、甘油三酯(TG)、三头肌皮褶厚度(TSF)、上臂肌围(AMC)、淋巴计数(TLC)等。并观察其营养不良反应及并发症,机械通气的天数等情况。计量资料用t检验,计数资料用卡方检验,P＜0.05为有统计学意义,所有统计均使用SPSS 13.0统计软件进行。结果①治疗10天后前白蛋白、转铁蛋白均有所改善,治疗组改善更为明显,两组间比较有显著差异(P＜0.05),有统计学意义。②研究示白蛋白、上臂肌围、三头肌皮皱厚度两组在EN支持前后无明显变化,无统计学意义(P＞0.05)。③治疗组在改善呼吸功能方面更优于对照组,机械通气天数明显少于对照组,差异有统计学意义(P＜0.05)。结论添加中医药四君子汤的肠内营养剂比单纯给予肠内营养剂更能改善机械通气患者的营养状况,治疗10天后营养指标如白蛋白、前白蛋白、转铁蛋白、血红蛋白均有所升高,治疗组改善更加明显,与对照组相比,差异有统计学意义(P＜0.05),且能改善患者的呼吸功能,缩短机械通气的时间。证实了中医药在危重病营养支持确有一定的应用前景。更多还原

【Abstract】 Background:Mechanical ventilation has became a popular method in Intensive Care Unit The incidence of malnutrition in patients with mechanical ventilation is very high,which is one of the principal causes to result in ventilator dependence. these patients are characterized by high metabolic response earlier period,The main reason of the high occurrence of malnutrition in the mechanical ventilation patients is supply deficiency and consumption increase.The purpose of nutritional support is to positively prevent or decrease atrophy and functional decline of the respiratoy muscle group,the before reasearch showed that single nourishment support support couldn’t reverse the critically ill patient’s high catabolism.Objective:The objective of this study is to explore the impact of Si-Jun-Zi combined with routine nutritional status in ICU patients with mechanical ventilation by comparing with those of simple nourishment suppot,thus provide the evidence for correctly applying Si-Jun-Zi in clinics.Methods:Fifty cases of the ICU patients with mechanical ventilation were selected in this hosptial from Apral in 2007 to February in 2009,and randomly divided into two groups,namely,one group received nourishment support combined with Si-Jun-Zi as experiment,the other group received only nutritional support as control.Detecting these nutritional markers as follows in two groups on the first day before the nourishment therapy,on the tenth day after treatment. marker:Albumin(ALB)、Prealbumin(PA)、Transferrin(TRF)、Cholesterol(TC)、Triglyceride(TG)、Hemoglobin(Hb)、Arm muscle circumference(AMC)、Friceps skinfold thickness(TSF).And to observe their response and complications of malnutrition,the number of days of mechanical ventilation and so on. Statistical method:describing all the datum with meant士variance,if P＜0.05,the difference is significant.Results:①10days after the treatment of pre-albumin,transferrin,hemoglobin, such as nutrition indicators have improved more significantly improve the treatment group,comparison betweenthe two groups were significantly different(P＜0.05),there is statistical significance.②research showed albumin,arm muscle circumference,Friceps skinfold thickness in the EN support group no significant changes before and after,there was no significant (P＞0.05).③the treatment group to improve the respiratory function in more than the control group,the number of days of mechanical ventilation significantly less than the control group,the difference was statistically significant(P＜0.05).Conclusion:Nutritional support is essential therapy measurment for reducing or redressing complication,early weaning and helping the patients recovery successfully,the Si-Jun-Zi added nutritional support has much more effects on improving nutritional status as compared with those of simple nutritional support while the mechanical ventilation patients are performed the nourishment therapy.Enteral nutrition support conforms to the physiological condition of mechanical ventilation and increase the achievement ratio of ventilation weaning.Confirmed that Chinese medicine nutritional support in critically ill patients there are certain applications.更多还原