| Objective: Affected by trauma, stress and other factors, critically ill patientsare in the high catabolic state, energy consumption increased, at the same time,critically ill patients present with gastrointestinal dysfunction, delayed gastricemptying, which limit the implementation of enteral nutrition, leading tonutrient supply can’t reach the target amount of nutrient. Malnutrition willlead to poor performance for the prognosis of critically ill patients, infectioncomplication rate increased, mortality increased, hospitalization prolonged.Therefore, nutrition therapy is an important part of the treatment of criticallyill patients. The implementation of the traditional way of intestinal nutrition isgradually increased enteral nutrition pumping speed hourly, which resulted inpatients achieving energy demand amount is longer.This way is not conduciveto the recovery of patients. In order to achieve the goal as soon as possiblewith energy demand, we start feeding to target velocity, while improving thegastric residual threshold, application of prokinetic agents, promotinggastrointestinal peristalsis. The study compares the traditional mode of feeding(control group) and early feeding (treatment group) on nutritional status ofpatients, incidence rate of nausea, vomiting, abdominal pain, diarrhea, the totalduration of hospitalization, ICU stay time, mechanical ventilation time ofhospitalization, evaluates the value of early enough feeding in clinicalapplication.Methods: Eighty critically ill patients were randomly divided into2groups, namely treatment group (early enteral nutrition, application ofprokinetic agents, improving gastric residual threshold) and the normal controlgroup,40patients in each group. There were no significant differencesbetween the two groups in age, sex, body weight, APACHEII score, withcomparable. Two groups of patients were treated anti-infective and with symptomatic treatment of the same support in the hospital.Enteral nutrition implementation method:All patients use of enteral nutrition early, enteral nutrition is started inICU within24-48hours; set the energy supply target is20-25kcal/kg/day;because of critically ill patients often have different degrees of edema, theactual weight of error, this experiment adopts the ideal body weight; nutritionpreparates through nasogastric infusion, and uses enteral nutrition infusionpump to control the infusion rate and dosage; patients maintain asemi-recumbent (head elevation30degrees), even in the lateral position alsokeep head elevation30degrees; the primary diseases were given conventionaltreatment, including adequate fluid resuscitation, improving microcirculation,infection control, protection of vital organ function, monitoring and the strictcontrol of blood glucose, correcting water electrolyte and acid-base imbalance.Two groups of patients choose appropriate enteral nutrition preparationaccording to their tolerance.Control group: To supply energy in the routine way (dosage graduallyincreases to the target heat supply): starting of enteral nutrition firstly at thespeed of25ml/h through a nasogastric tube using enteral nutrition infusionpump, monitor gastric residual every4hours, if gastric residual≤200ml,maintain the original speed of infusion; if the gastric residual≤100ml, enteralnutrition feeding rate will be increased by20ml/h every4hours. If the residualgastric volume for2or more than2times more than200ml, it shalltemporarily stop infusion or reduce the speed of infusion.The treatment group:(1)calculating daily energy requirement is20-25kcal/kg (ideal body weight).(2) the enteral nutrition preparation is totalprotein and short peptide.(3) the implementation way of enteral nutrition:To determine the total calorie of enteral nutrition with daily needs ofpatients, select the appropriate enteral nutrition preparation, calculate the totalpreparation, calculation of the average speed of infusion: if the patient feeddemand is1500ml/day, so infusion at a rate of62.5ml every hour. If pausingfor a few hours of feeding because of clinical examination, only received400 ml, remaining9hours, then in the remaining9hours, feeding speed isadjusted to the (1100ml/9h)122ml/h. The next day feeding speed begins from62.5ml/h. Setting the maximum infusion speed is150ml/h. Critically illpatients were given prokinetic agents at the start of enteral nutrition:metoclopramide10mg Q8H intramuscular injection. Improvement of gastricresidual threshold to300ml.Nutrition supporting treatment lasted for3~7days, blood routine andbiochemical indexes (albumin, prealbumin, liver function, renal function)were recorded before application of enteral nutrition, the application of enteralnutrition after third days, the application of enteral nutrition after seventh days,the incidences of nausea and vomiting, abdominal pain, diarrhea and othercomplications were recorded, and the time of mechanical ventilation, ICU stay,hospital stay were recorded.Results: Before the supply of enteral nutrition,the nutritional indexes andliver function of patients in the two groups showed no significant difference (P>0.05). After nutritional therapy, serum albumin (32±4vs24±5), prealbumin(18±3vs14±5) of the treatment group was significantly higher than that inthe control group, liver function was also improved, the difference wasstatistically significant (P <0.05). There was no statistically significant withhemoglobin and urea nitrogen between the two groups of patients (P>0.05).The mechanical ventilation time (9.97±5.24vs13.05±5.04days), the lengthof ICU stay (13.85±8.08vs17.61±6.35days), The total length of hospital stay(20.90±8.89vs26.05±7.97days)in the treated group were significantlyshorter than the control group, there are significant differences(P <0.05).Compared with the contral group, the time of target volume of theexperimental group was shorter （51.40±5.08vs112.22±8.38hours）,thedifference was statistically significant (P <0.05).The incidence rate of nausea,vomiting(12%vs7.5%),abdominal distension (18%vs15%),diarrhea (5%vs7.5%) in the two groups of patients had no significant difference (P>0.05).Conclusion: Early application of prokinetic agents, while improving thegastric residual threshold, remedy for enteral nutrition infusion time because of examination and treatment delay, can promote to reach the goal of energysupply in critically ill patients, improve the nutritional status of patients,shorten the time of mechanical ventilation, the stay of intensive care unit andhospital, the time of target nutritional volume, also did not increase theincidence of related complications. |
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