| Objective:Early Enteral nutrition (EN) can not only provide nutrients, and because of its protection and function of intestinal mucosa, reduce bacterial translocation, enhance immunity, reduce stress, such as treatment effect has been widely used in critically ill patients, but its dose is still controversial, various guidelines and clinical studies show different results.6 years of European enteral nutrition guidelines recommend patients with acute period should be given 20-25 kcal/kg·d;08 Australia within 72 h of nutrition guidelines recommend giving 80% or higher energy requirements of enteral nutrition;09 American nutrition guidelines recommend 1 weeks to> 50%-65% of the energy demand of enteral nutrition, but the level of these recommendations are C level, the weak evidence; The recent two international multiple large sample size, according to a study by acute respiratory failure require mechanical ventilation in patients with early application of small dose of enteral nutrition (20 ml/h) compared with the full amount early enteral nutrition, can significantly improve the feeding tolerance, and does not affect the new infections, organ support, mortality, such as clinical results, reflecting the small dose some advantages of early enteral nutrition. But the two studies are in view of the patients with mechanical ventilation, the gastrointestinal function is normal, there are obstacles; We think that the application of enteral nutrition is affected by gastrointestinal function, should be based on the gastrointestinal function is normal. And acute gastrointestinal dysfunction is a common problem of critically ill patients and its development have a direct relationship with poor prognosis. Early enteral nutrition as an important treatment method of acute gastrointestinal dysfunction, can give appropriate doses of early enteral nutrition is vital for the recovery of disease. Due to acute gastrointestinal dysfunction in patients with gastrointestinal power itself, such as digestion and absorption function is impaired, the application of early enteral nutrition feeding intolerance are more likely to happen. If the patients with acute gastrointestinal dysfunction early application of small dose of enteral nutrition, can be like patients with mechanical ventilation, feeding tolerance was improved? And other clinical results will be what kind of impact? These are worth exploring, but the literature, the current lack of related research reports. Therefore, our study was to observe different doses of early EN feeding intolerance in patients with acute gastrointestinal dysfunction, and new infections and other complications, the influence of the inflammatory index and prognosis. Methods Select acute gastrointestinal dysfunction Ⅱ grade standard and EN support of critically ill patients, ruled out with enteral nutrition taboos, hemodynamic instability, it is difficult to correct the shock or a dying state, application of total Parenteral nutrition (TPN), severe liver and kidney disease, thyroid function hyperfunction, short bowel syndrome, severe neuromuscular disease, severe malnutrition, psychiatric history, pregnancy or lactation women, a total of 120 patients, according to random number table method divided into the conventional dose group (n= 60) and low dose group (n = 60). Routine dose group EN speed 20 ml/h, according to tolerance every 12 hours add 10 ml/h 3 days, if still not 60% hot card, add Parenteral nutrition (PN) in order to achieve target calories;Low dose group of line EN speed 20 ml/h,7 d in a row,3 days start adding PN target calorie,7 d after EN gradually add to the full amount. To compare two groups of patients in the ICU days, ICU mortality and hospitalization days, and in-hospital mortality, organ support, continuous renal replacement therapy (mechanical entilation and asoactie drugs) the number of new infections,7 d and 28 d, 7 d in the incidence of feeding intolerance and C reaction protein (CRP) Procalcitonin(PCT) and tumor necrosis factor -α(TNF-α), interleukin 6-(IL-6) inflammatory indexes such as level. Results (1) the prognosis:low dose group with regular doses of ICU days (11.77±8.49 vs.17.2±14.72), hospitalization days (31.42±13.21 vs.32.92±18.98), ICU mortality (5% VS 6.7%), hospital mortality rates (11.7% VS 15%), and other indicators, had no statistical difference (P> 0.05);Support:(2) the organs in the number of days of mechanical ventilation (10.38 ±7.82 vs.10.92±.48 d), CRRT days (4.73±2.95 vs.4.87±2.76 d), vascular active drug application number (8.54±6.27 vs.9.13±6.87 d) organ function support the indexes such as no statistical difference;(3) new infections:7 d new infections (31.7% vs 35.0%) and 28 d new infections (48.3% vs 53.3%) had no statistical difference (P> 0.05);2 days (4):feeding tolerance, low dose group, the incidence of feeding intolerance is lower than the conventional dose group, and with the increase of number of days to reduce gradually, the difference was statistically significant (P< 0.0.5);Conventional dose groups increased incidence of feeding intolerance,7 days and low dose group biggest difference (36.7% VS 13.3%, P< 0.05);(5) inflammatory indicators:1,3,7 days, the conventional dose group of CRP levels for [(41.4±7.3), (31.5±6.5) and (14.6.16±3.2) ng/L], PCT level [(16.2± 3.9), (10.4-2.5) and (3.2±0.8 ng/mL).Low dose group of CRP level [(38.7±6.1), (30.3±5.6) and (15.7±3.1 ng/L), PCT level [(13.2±.1), (7.6±1.9) and (3.7 ±0.7 ng/mL). Two groups of CRP and PCT levels are increasing gradually reduce the number of days; the same time to compare differences between the two way had no statistical significance (P> 0.05), and compare the differences of different time points in the group had statistical significance (P< 0.05); Routine dose group level of TNF-α 1,3,7 days for [(18.9±3.8), (15.6±3.5) and (10.8±3.4 ng/L], IL-6 level [(29.5 ±8.1), (35.7+8.1) and (20.5±6.4 ng/L], low dose group of TNF-α level [(14.7± 2.7), (13.7±4.4) and (7.8±2.9 ng/L], IL-6 levels for [(30.4±9.6), (26.6-7.9) and (18.2± 6.3 ng/L].Two groups of TNF-α and IL-6 levels the same as the number of days increase, in turn, reduce; Same time to compare differences between the two way had no statistical significance (P> 0.05), the comparison group in different time points, the differences were statistically significant (P< 0.05). Conclusions 1. Compared with the conventional dose of early enteral nutrition, low doses of early enteral nutrition can significantly improve the feeding tolerance in patients with acute gastrointestinal dysfunction; 2. Compared with the conventional dose of early enteral nutrition, low doses of early enteral nutrition support in patients with acute gastrointestinal dysfunction organs days, new infections, such as mortality had no obvious effect; 3. Compared with the conventional dose of early enteral nutrition, low doses of early enteral nutrition in patients with acute gastrointestinal dysfunction related to inflammation index had no obvious effect. |
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