Enteral Nutrition Combined With Supplemental Parenteral Nutrition In Critically Ill Patients In The Clinical Value

Objective: Malnutrition often happens when the body suffer from the disease, sonutritional support is extremely important, especially in critically ill patients."Nutritional support in critical guidance patients (draft)" tell us that patients with severeacute stress nutritional support should follow "permissive low calorie" principle; whenbody in stress and metabolic state is stable,the energy supply could be increased(Cgrade). To avoid adding to the burden of the gastrointestinal tract in patients,considering most of the energy supply by enteral nutrition(EN), a small part of theenergy can be supplemented by parenteral nutrition, that we can call supplementalparenteral nutrition(SPN). This study was designed to compare simply enteral nutritionto early enteral nutrition combined with parenteral nutrition, which method has theadditional clinical value of parenteral nutrition.Methods: We collected85patients in Second Affiliated Hospital of Dalian MedicalUniversity from December2012to December2013who is under nutritional risk, andthey were randomly divided into experimental group and control group. The controlgroup only use enteral nutrition method, to continued feed LiShiKang from thenasogastric within8hours everyday. LiShiKang appropriate energy supply is498kcal/500ml/bottle, according to20~25kcal/kg· d supply, and rinse nasogastricwith100ml warm water per hour, and withdrawing gastric juice every1hour to decidewhether there gastric retention is. The experimental group were fed with enteral nutrition combined supplementary parenteral nutrition, which in the first three days offeeding method was similar to the control group.From the forth day the experimentalgroup’s patients should be added100ml acid-glutamine injection and500ml18kindsof amino acid injection intravenous infusion. Then analysis the relationship of the agedistribution of patients,admission NRS score, the worst24hours of admission APACHEⅡ score, as well as the upper arm circumference, serum creatinine and Prealbuminwhen the patient was in admission, the forth day and the end point.Results:1. The study found that the age,sex, admission NRS score and APACHEⅡ score between the experimental group and the control group was not statisticallysignificant(P>0.05).2. The average upper arm circumference when admission of theexperimental group and the control group were22.79mm and23.19mm, P>0.05, thedifference was not statistically significant.In the third day, the average upper armcircumference of the experimental group and the control group were increased, whatwas22.94mm and23.26mm, but P>0.05,the difference was not statisticallysignificant.And in the end point, the numbers were23.88mm and24.83mm, and alsoincreased compared with before, but P>0.05, the difference also was not statisticallysignificant.3. The average prealbumin when admission of the experimental group andthe control group were162.47mg/L and141.92mg/L, P>0.05,the difference was notstatistically significant.In the forth day, the average prealbumin of the experimentalgroup and the control group were increased, what was164.04mg/L and141.92mg/L,but P>0.05, the difference was not statistically significant. And in the endpoint, the number were207.06mg/L and172.82mg/L and also increased compared withbefore, but P <0.05,the difference was statistically significant.4. The average serumcreatinine when admission of the experimental group and the control group were56.50μmol/L and56.37μmol/L, P>0.05, the difference was not statistically significant.In the forth day, the average serum creatinine of the experimental group and the controlgroup were increased, what was59.29μmol/L and59.77μmol/L, but P>0.05, thedifference was not statistically significant. And in the end point,the number were76.01μmol/L and74.10μmol/L, and also increased compared with before, but P <0.05, the difference was statistically significant.5. Complication rate in the experimentalgroup there were four cases, accounting for about9.1%in the experimental group; thecontrol group had five cases, accounting for12.20%of the control group. Thedifference was not statistically significant.6. End point for patients in the experimentalgroup3deaths, accounting for6.82%in the experimental group; for the control group,4patients died, accounting for9.76%of the control group. The difference was notstatistically significant.Conclusion:1. An early start of enteral nutrition patients can be benefited, whichcan effectively improve upper arm circumference, serum creatinine, and prealbuminlevels, protect vital organs’ function.2. Supplemental parenteral nutrition combinedwith enteral nutrition compared to enteral nutrition alone can more effectively improvethe body’s nutritional status, improve immunity, but the incidence of complications andpatient mortality rates had no significant advantage.