标题：容许性低热量喂养与足量喂养对机械通气重症患者病情转归的影响

      作者：梁国源，吴苏华，张宗满，李远华    东莞市第八人民医院成人重症监护室，广东 东莞 523320

      卷次： 2021年32卷16期

      【摘要】 目的 分析足量喂养与容许性低热量喂养对机械通气重症患者病情转归的影响。方法 选取2020年3~12月东莞市第八人民医院收治的60例机械通气重症患者为研究对象，按照随机数表法将患者分为对照组和研究组，每组30例。对照组患者予以足量喂养，研究组患者实施容许性低热量喂养，疗程1周。比较两组患者治疗前后的血清总蛋白(TP)、前白蛋白(PA)、血红蛋白(HGB)、白蛋白(ALB)以及血清降钙素原(PCT)、血清超敏C-反应蛋白(hs-CRP)水平的变化；比较两组患者每日胰岛素用量、机械通气时间、ICU住院时间、28 d内致死率、院内感染及不良反应情况。结果 治疗后，研究组患者的TP、PA、HGB、ALB、PCT、hs-CRP水平略低于对照组，但差异均无统计学意义(P>0.05)；治疗后，研究组患者的机械通气时间、ICU住院时间略长于对照组，28 d内致死率、院内感染发生率略低于对照组，但差异均无统计学意义(P>0.05)；研究组患者的每日胰岛素用量为(13.67±3.36) U，明显低于对照组的(26.26±4.54) U，差异有统计学意义(P<0.05)；研究组患者的不良反应总发生率为23.33%，明显低于对照组的50.00%，差异有统计学意义(P<0.05)。结论 容许性低热量、足量喂养两种喂养方式对机械通气重症患者的疗效相当，但前者可有效降低胰岛素的用量，且能控制不良反应的发生风险。
      【关键词】 容许性低热量喂养；足量喂养；机械通气；重症患者；病情转归；炎性因子
      【中图分类号】 R653 【文献标识码】 A 【文章编号】 1003—6350（2021）16—2094—04

Effects of permissive low calorie feeding and adequate feeding on the prognosis of patients with severe mechanicalventilation.
LIANG Guo-yuan, WU Su-hua, ZHANG Zong-man, LI Yuan-hua. Adult Intensive Care Unit, DongguanEighth People's Hospital, Dongguan 523320, Guangdong, CHINA
【Abstract】 Objective To analyze the effects of adequate feeding and permissive low calorie feeding on theprognosis of severe patients with mechanical ventilation (MV). Methods Sixty patients with severe MV in DongguanEighth People's Hospital from March 2020 to December 2020 were randomly divided into two groups: the control groupand the study group. The control group (30 cases) was given adequate feeding, and the study group (30 cases) was givenpermissive low calorie feeding. The course of treatment was 1 week. The levels of serum total protein (TP), prealbumin(PA), hemoglobin (HGB), albumin (ALB), procalcitonin (PCT), and high sensitivity C-reactive protein (hs-CRP) werecompared between the two groups before and after treatment. The daily insulin dosage, duration of mechanical ventila-tion, length of ICU stay, 28 d mortality, nosocomial infection, and adverse reactions were compared between the twogroups. Results After treatment, the levels of TP, PA, HGB, ALB, PCT, and hs-CRP in the study group were slightlylower than those in the control group, but the differences were no statistically significant (P>0.05). After treatment, theduration of mechanical ventilation and ICU stay in the study group were slightly longer than those in the control group,and the 28 d mortality rate and the incidence of nosocomial infection in the study group were slightly lower than those inthe control group, but the differences were no statistically significant (P>0.05). The daily insulin dosage in the study groupwas (13.67±3.37) U, significantly lower than (26.26±4.54) U in the control group (P<0.05). The incidence of adverse reac-tions in the study group (23.33%) was lower than that in the control group (50.00%), and the difference was statistically sig-nificant (P<0.05). Conclusion Permissive low calorie feeding and adequate feeding have the same effect on severe MVpatients, but the former can effectively reduce the dosage of insulin and control the risk of adverse reactions.
      【Key words】 Permissive low calorie feeding; Adequate feeding; Mechanical ventilation; Severe patients; Progno-sis; Inflammatory factors