包振明，陈华，张丹凤，王丽娥，吴银霞

(南京军区福州总医院干部病房一科，福州 350025)

·论著·

肠内营养在老年心力衰竭患者急性期的应用

包振明，陈华，张丹凤，王丽娥，吴银霞

(南京军区福州总医院干部病房一科，福州 350025)

[摘要]目的探讨肠内营养支持在老年心力衰竭急性发作期应用对患者预后的影响。方法选取慢性心力衰竭急性发作或急性心力衰竭患者共62例用随机数字表法分为肠内营养组(EN)31例及肠外营养组(PN)31例，同时积极治疗原发疾病，合理应用利尿剂、血管扩张剂、洋地黄类药物，注意水电解质、酸碱平衡。观察患者在14 d后部分指标的变化(血清白蛋白、前白蛋白、血红蛋白、中心静脉压、脑利钠肽、生存例数)。结果经治疗后，EN组血清白蛋白、前白蛋白均显著升高(P<0.01)，血红蛋白、中心静脉压差异不大(P>0.05)；PN组血清白蛋白显著升高(P=0.036)，但幅度低于EN组，血红蛋白下降(P=0.002)、中心静脉压显著升高(P=0.001)显著；两组血清B型尿钠肽(BNP)水平均明显下降，而EN组的BNP下降幅度略高于PN组(P=0.057)。EN组生存率显著高于PN组(χ2=4.24，P=0.036)。结论合理运用肠内营养支持有助于改善老年心力衰竭急性发作期患者的预后。

[关键词]心力衰竭；肠道营养; 血清白蛋白；老年人

Application of enteral nutrition in elderly patients with heart failure during the acute periodBaoZhenming,ChenHua,ZhangDanfeng，WangLi′e,WuYinxia(DepartmentIofGeriatrics,FuzhouGeneralHospitalofNanjingMilitaryRegion,Fuzhou350025，China)Correspondingauthor:ZhangDanfeng,Email:785649471@qq.com

[Abstract]ObjectiveTo discuss the effect of enteral nutrition for the elderly patients with acute exacerbation of chronic heart failure on the prognosis.Methods62 inpatients with chronic heart failure from September 2012 to September 2014 were randomly divided into two groups,group EN (enteral nutrition,31 cases) and group PN (parenteral nutrition,31 cases).The serum albumin，prealbumin,hemoglobin,central venous pressure ,brain natriuretic peptide and the number of survival patients after 14 days were observed.ResultsAfter the treatment,the level of serum albumin in EN group was significantly elevated(P<0.01),the level of hemoglobin,central venous pressure made little change in EN group,however,the level of serum albumin elevated significantly (P=0.036),but less extent than EN group(P<0.01)，prealbumin level made little change,meanwhile the level of hemoglobin fell(P=0.002)and central venous pressure rise (P=0.001) in PN group; BNP in both group fell significantly(P<0.01).The survival rate of EN group was significantly higher than that of PN group.ConclusionRationally using enteral nutrition support is helpful to improve the prognosis of the elder patients with acute exacerbation of chronic heart failure.

[Key words]Heart failure; Enteral nutrition; Serum albumin;Aged.

心力衰竭已成为老年人住院和死亡的主要因素[1]。心力衰竭急性发作期的患者由于气喘加重、胃肠道淤血所致功能不全等因素，食欲明显减退，纳差，甚至不愿进食、无法进食，临床上常用的营养支持治疗有胃肠内营养(EN)或肠外营养(PN)。近期的一些研究提示，营养支持对于急性心力衰竭及慢性心力衰竭急性发作患者的预后起着重要作用，可为其他治疗手段的成功应用提供支持，甚至可决定危重患者的预后[2]。……