余栋栽　林熙泉　谭家香　张旺龙　温嘉强　吴彬　梁丹青

[摘要]目的 探討早期肠内营养对重症患者院内感染及多重耐药菌感染的临床效果。方法 选取2017年4月～2018年12月在我院住院治疗的200例危重症患者作为研究对象，根据随机数字表法将其分为对照组和治疗组，每组各100例。对照组患者采用早期肠外营养治疗及延迟肠内营养，治疗组患者采用早期肠内营养治疗。比较两组患者的治疗总有效率;比较两组患者的ICU住院时间;比较两组患者治疗前后的降钙素原、C反应蛋白、CD4+淋巴细胞/CD8+淋巴细胞比值;比较两组患者的血常规、肝肾功能。结果 治疗组患者的治疗总有效率高于对照组，ICU住院时间短于对照组，治疗后的降钙素原、C反应蛋白水平低于对照组，CD4+淋巴细胞/CD8+淋巴细胞比值高于对照组，差异有统计学意义（P<0.05）。治疗组患者的院内感染发生率、多重耐药菌感染发生率低于对照组，差异有统计学意义（P<0.05）。结论 早期肠内营养对重症患者院内感染及多重耐药菌感染的临床预防效果确切，值得应用推广。

[关键词]早期肠内营养;重症患者;院内感染;多重耐药菌感染;临床研究

[中图分类号] R473.5     [文献标识码] A     [文章编号] 1674-4721（2019）11（c）-0045-03

Clinical study of early enteral nutrition on nosocomial infection and multi-drug resistant infection in critically ill patients

YU Dong-zai   LIN Xi-quan   TAN Jia-xiang   ZHANG Wang-long   WEN Jia-qiang   WU Bin   LIANG Dan-qing

Department of Critical Care Medicine， Kaiping Central Hospital， Guangdong Province， Kaiping   529300， China

[Abstract] Objective To investigate the clinical effect of early enteral nutrition on nosocomial infection and multi-drug resistant infection in critically ill patients. Methods A total of 200 critically ill patients admitted into our hospital from April 2017 to December 2018 were selected as subjects. They were divided into control group and treatment group according to the random number table method， with 100 cases in each group. In the control group， early parenteral nutrition and delayed enteral nutrition were used， while in the treatment group， early enteral nutrition was adopted. The total effectiveness rate of the two groups was compared between the two groups. The duration of intensive care unit （ICU） stay， the levels of procalcitonin and C-reactive protein， and the ratio of lymphocytes CD4+ to CD8+ before and after treatment were compared between the two groups. The blood routine， liver and kidney function were also compared between the two groups. Results The total effectiveness rate in the treatment group was higher than that of the control group， the ICU stay was shorter than that of the control group， the levels of the procalcitonin and C-reactive protein after treament were lower than those of the control group， the ratio of CD4+ to CD8+ in lymphocytes was higher than that of the control group， the differences were statistically significant （P<0.05）. The incidence of nosocomial infection and multi-drug resistant infection in the treatment group were lower than those in the control group， the differences were statistically significant （P<0.05）. Conclusion Early enteral nutrition is effective in the prevention of nosocomial infections and multi-drug resistant infections in critically ill patients， is worthy of application and promotion.

[Key words] Early enteral nutrition; Critically ill patients; Nosocomial infection; Multi-drug resistant infection; Clinical study

重症患者作为临床医院感染发生的高危群，院感的发生极大地影响到其原发疾病的治疗效果，重症患者多重耐药菌（MDROs）感染率呈持续上升趋势，且MDROs感染者的治疗难度和住院费用增加，ICU住院时间和总住院时间明显延长，住院病死率显著增加。早期肠内营养能降低应激相关的分解代谢，目前尚未见早期肠内营养对于重症患者院内感染及MDROs感染的影响，因此，本研究拟纳入临床重症患者，通过早期肠内营养支持，监测患者院内感染发生率、MDROs感染发生率，评价早期肠内营养对重症患者产生的影响，进而起到改善预后的目的，为早期肠内营养治疗提供理论依据[1-2]。……