Investigation On The Status Of Nutritional Support In Critically Ill Patients And The Efficacy Of Probiotics In Elderly Patients With Sepsis

ObjectiveTo investigate the status of nutritional support among critically ill patients in Nanjing Drum Tower Hospital,and to provide evidence for further improvement of nutritional support for critically ill patients.MethodsWe retrospectively surveyed the clinical data of the critically ill patients admitted to ICU of Nanjing Drum Tower Hospital from April to September 2016(Inclusion criteria:age≥18 years,length of ICU stay>7 days;Exclusion criteria:brain death,advanced malignant tumor,patients with incomplete information).We filled in the "The registration form of ICU patients’ nutritional support survey" daily,which include the date,NRS2002 score,APACHE Ⅱscore,diagnosis,nutrition support way and actual calorie intake,and took horizontal statistics of the implementation of nutritional support.According to the information of "The registration form of nutritional support survey for ICU patients",we analyzed the data and filled in the "The summary statistics form of nutritional support survey for ICU patients",which include age,gender,diagnosis,actual calorie intake and protein intake from the first day to seventh day and the starting time of nutritional support,and took vertical statistics of the implementation of nutritional support.We analyzed the nutritional risk,the start time and target time of nutritional support and the incidence of gastrointestinal adverse reactions during nutritional support of all patients,and compared the nutritional risk,nutritional support status and clinical prognosis between the elderly group(age≥60years)and non-elderly group(age<60years).Results1.181patients were finally enrolled,and 179 patients(98.9%)had nutritional risk scores≥3.The nutrition supp.ort started at 42(24-70)hours after admission.At the beginning of nutrition support,12 cases(61.88%)were adopted for enteral feeding,and 69 cases(38.12%)adopted for parenteral nutrition support.At the time of nutritional target achieved,there were 114 cases(67.46%)adopted for enteral nutrition,37 cases(21.89%)adopted for parenteral nutrition,and 18 cases(10.65%)adopted for enteral nutrition combined with parenteral nutrition.All enteral feeding patients were monitored for the presence of gastric remnant There were 7 cases(3.87%)of vomiting,and 70 cases(38.67%)of diarrhea.2.The scores of NRS2002 in the elderly group(3.95±0.93)were all>3,which was significantly higher than that of the non-elderly group(3.16±0.65)(P<0.05).The nutrition support of the elderly group(40(20-60)hours)started earlier than the non-elderly group(48(24-92)hours)(P<0.05).There was no statistically significant difference between the two groups in the nutrition support way(P>0.05).We compared the cumulative nutrition target cases between the two groups every day.There was no significant difference between two groups on the first day and the second day(P>0.05).The number of cumulative nutrition target cases in non-elderly group was more than the elderly group on the third day without significant difference(P>0.05).The number of cumulative nutrition target cases in non-elderly group was more than the elderly group on the fourth day and the fifth day with significant difference(P<0.05).The number of cumulative nutrition target cases in elderly group was more than the non-elderly group on the sixth day and the seventh day without significant difference(P=0.132).The incidence of diarrhea in the elderly group(46.85%)was significantly higher than that in the non-elderly group(25.71%)(P<0.05),and the incidence of vomiting was not significantly different between the two groups(P>0.05).There was no significant difference in the duration of mechanical ventilation,ICU hospital stay and 28-day mortality(P>0.05),but the length of ICU stay in non-elderly group appeared to be shorter than that of elderly group.ConclusionThere was high incidence of nutritional risk in critically ill patients,which was higher in elderly patients.Patients with high nutritional risk started early nutritional support within four days after admission,and the elderly patients started nutritional support earlier.Nutritional support with enteral was the leading way.Most patients achieved the nutritional goal in one week,but the nutrition target rate within seven days of elderly group was lower than non-elderly group,which may due to the occurrence of gastrointestinal intolerance reactions(diarrhea)frequently.ObjectiveWe aimed to analyze the influence of early enteral nutrition with added probiotics on the serum inflammatory factors and gastrointestinal complications of elderly patients with sepsis.Methods122 patients with sepsis admitted to ICU of Jiangsu Province Geriatric Hospital from January 2014 to December 2016 were enrolled.Patients included were randomly divided into the observe group(early enteral nutrition with added probiotics,n=61)and control group(early enteral nutrition,n=61).The general characteristics and the levels of the inflammatory factors before and after treatment(CRP,IL-6,TNF-α,PCT)and the incidence of gastrointestinal complications(diarrhea and vomiting)in two groups were compared.ResultsThere was no statistical difference of the general characteristics and the levels of the inflammatory factors before treatment between two groups(P>0.05).After treatment,the levels of CRP((9.8±5.1)vs(16.5±8.3)mg/L,P<0.05),IL-6(19.3±4.7)vs(40.3 ± 3.8)ng/L,P<0.05),TNF-α((28.4±19.5)vs(34.6±20.7)ng/L,P<0.05),PCT((0.6±0.2)vs(1.6±0.6)ng/L,P<0.05)in observe group were obviously lower than control group.There was no significant difference in the incidence of diarrhea and vomiting between the two groups(P>0.05).ConclusionThe early enteral nutrition with added probiotics could significantly decrease the levels of inflammatory factors of the patients with sepsis,but the incidence of gastrointestinal complications was not significantly reduced.