Effect analysis of early enteral nutrition tolerance grading intervention in patients with severe illness
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摘要: 目的 研究早期肠内营养(EEN)耐受性分级干预对重症患者的应用效果。方法 将我院2018年1月1日—2021年1月31日期间收治的87例重症患者纳入研究。以电脑随机数字表法将其分成分级组43例和对照组44例。对照组开展常规肠内营养干预；分级组则开展EEN耐受性分级干预方案进行干预。分析2组热卡达标情况，干预前后营养指标变化情况，喂养不耐受症状情况，干预前后免疫状况以及胃肠激素水平变化情况等方面的差异。结果 分级组干预7 d后、14 d后的热卡达标例数占比均高于对照组(均P< 0.05)。干预后分级血清白蛋白以及总蛋白水平均高于对照组(均P< 0.05)。分级组喂养不耐受症状总发生率低于对照组(P< 0.05)。干预后分级组IgA以及IgG水平均高于对照组(均P< 0.05)。分级组干预后血清胃动素(MTL)水平高于对照组，而血管活性肽(VIP)水平低于对照组(均P< 0.05)。结论 EEN耐受性分级干预对重症患者的应用效果显著，可明显改善患者的营养状况，减少喂养不耐受症状的发生，促进免疫功能的增强，值得临床推广应用。Abstract: Objective To study and analyze the effect of early enteral nutrition(EEN) tolerance grading intervention in patients with severe illness.Methods From January 1, 2018 to January 31, 2021, 87 patients with severe illness were included in the study. The patients were divided into grade group(n=43) and control group(n=44) by computer random number table. The control group received routine enteral nutrition intervention; The grade group received EEN tolerance graded intervention program. The differences between the two groups in calorie standard, changes in nutritional indicators, feeding intolerance symptoms, immune status and changes in gastrointestinal hormone levels before and after intervention were analyzed.Results The proportion of the number of people reaching the standard of calorific acid in grade group was higher than that in control group after 7 d and 14 d intervention(allP< 0.05). After intervention, serum albumin and total protein levels in grade group were higher than those in control group(allP< 0.05). The total incidence of feeding intolerance symptoms in grade group was lower than that in control group(P< 0.05). After intervention, IgA and IgG levels in grade group were higher than those in control group(allP< 0.05). After intervention, the level of serum MTL in graded group was higher than that in control group, while the level of VIP was lower than that in control group(allP< 0.05).Conclusion EEN tolerance grading intervention has a significant effect on severe patients, which can significantly improve the nutritional status of patients, reduce the occurrence of feeding intolerance symptoms, and promote the enhancement of immune function. It is worthy of clinical promotion and application.
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表 1 2组热卡达标情况评价
例(%) 组别 例数 4 d 7 d 14 d 分级组 43 4(9.30) 13(30.23)1) 21(48.84)1) 对照组 44 5(11.36) 4(9.09) 10(22.73) χ2 0.100 6.183 6.464 P 0.752 0.013 0.011 与对照组相比，1)P < 0.05。 
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表 2 干预前后2组营养指标评价
组别 例数 血清白蛋白 血清总蛋白 干预前 干预后 干预前 干预后 分级组 43 31.52±4.15 37.66±5.061) 42.51±5.28 50.69±6.231) 对照组 44 31.60±4.18 33.42±4.43 42.74±5.31 46.45±5.68 t 0.090 4.161 0.203 3.319 P 0.929 ＜0.0011 0.840 0.001 与对照组相比，1)P < 0.05。
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表 3 2组喂养不耐受症状评价
例 组别 例数 恶心呕吐 腹痛/腹胀 腹泻 其他 总发生率/% 分级组 43 2 10 3 2 39.531) 对照组 44 5 15 6 3 65.91 χ2 6.071 P 0.014 与对照组相比，1)P < 0.05。
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表 4 2组免疫状况评价
g/L，x±s 组别 例数 IgA IgG 干预前 干预后 干预前 干预后 分级组 43 0.72±0.14 1.20±0.231) 7.43±0.66 10.89±1.241) 对照组 44 0.72±0.13 0.87±0.18 7.48±0.67 8.61±0.87 t ＜0.001 6.238 0.351 9.947 P 1.000 < 0.001 0.727 < 0.001 与对照组相比，1)P < 0.05。
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表 5 2组胃肠激素水平对比
g/L，x±s 组别 例数 MTL VIP 干预前 干预后 干预前 干预后 分级组 43 142.01±22.07 269.39±33.121) 82.33±10.06 56.32±7.141) 对照组 44 142.25±21.66 221.76±26.49 82.41±10.12 64.59±8.29 t 0.051 7.416 0.037 4.981 P 0.959 < 0.001 0.971 < 0.001 与对照组相比，1)P < 0.05。
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