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目的 比较两种不同类型肠内营养制剂对幽门后喂养重症患者的影响.方法 采用前瞻性研究方法,连续收集2016年1月至2018年12月,收治于天津市中医药研究院附属医院ICU和NICU病房具备幽门后喂养指征60例重症患者,随机(随机数字法)分为短肽型肠内营养(PBEN)组及整蛋白型肠内营养(IPEN)组,每组各30例.在鼻肠管置入后的24 h内,均立即启动肠内营养,其中PBEN组给予短肽型肠内营养剂治疗,IPEN组给予整蛋白型肠内营养剂治疗.观察比较肠内营养治疗后第7天和第14天的两组患者营养代谢指标、肠屏障指标,以及肠内营养过程中喂养并发症、喂养不耐受发生率、胃肠道适应性及7d肠内营养达标率.计数资料比较采用x2检验,计量资料比较采用LSD-t检验.结果 肠内营养治疗后的第7天及第14天,两组患者营养代谢指标差异均无统计学意义(P＞0.05),肠屏障指标比较中,PBEN组患者二胺氧化酶(DAO)水平均低于IPEN组同期水平,差异有统计学意义[(6.1±2.9) U/mLvs(7.8±2.7) U/mL,t=-2.354,P=0.019;(4.7±1.6) U/mL vs(6.9±2.0) U/mL,t=-3.285,P=0.004].肠内营养过程中,PBEN组患者腹泻比例略高于IPEN组(6.6％vs 3.3％),而IPEN组患者腹胀的比例略高(3.3％ vs 10％),但两组比较差异无统计学意义(均P＞0.05),PBEN组患者胃肠道适应时间短于IPEN组,差异有统计学意义[(7.8±1.3) hvs(9.1土2.0)h,t=-2.334,P=0.027],两组患者7d肠内营养达标率比较,差异无统计学意义(P＞0.05).结论 幽门后喂养的患者,PBEN组患者以腹泻为主要并发症,而IPEN组患者以腹胀为主.短肽型肠内营养剂可以早期修复幽门后喂养患者肠屏障功能,增加肠内营养初始阶段胃肠道的适应性.“,”Objective To compare the effects of two different types of enteral nutrition on postpyloric feeding critical ill patients.Methods A prospective study was conducted to continuously collect 60 critical ill patients with indications ofpost-pyloric feeding in ICU and NICU wards of our hospital from January 2016 to December 2018.They were randomly (random number) divided into the peptide-based enteral nutrition (PBEN) group and intact protein enteral nutrition (IPEN) group with 30 patients in each group.Enteral nutrition was started immediately within 24 h after the nasointestinal tube was placed,and the PBEN group was treated with peptide-based enteral nutrition,while the IPEN group was treated with intact protein enteral nutrition.The nutritional metabolism index,intestinal barrier index on the 7th and 14th days after enteral nutrition treatment were observed and compared.The enteral feeding complications,incidence of feeding intolerance,gastrointestinal adaptability and 7-day enteral nutrition compliance rate of the two groups during the enteral nutrition were also observed and compared.Chi-square test was used for counting data and t test was used for measuring data.Results On the 7th and 14th days after enteral nutrition therapy,there was no statistical difference in nutritional metabolism indexes between the two groups (P＞0.05).In comparison of intestinal barrier indexes,diamine oxidase (DAO) level in the PBEN group was lower than that in the IPEN group at the same time,and the difference was statistically significant [7th day:(6.1±2.9) U/mL vs (7.8±2.7) U/mL,t=-2.354,P=0.019;14th day:(4.7±1.6) U/mL vs (6.9±2.0) U/mL,t=-3.285,P=0.004].During enteral nutrition,the diarrhea rate of patients in the PBEN group was slightly higher than that in the IPEN group (6.6％ vs 3.3％),while the abdominal distension rate in the IPEN group was slightly higher (3.3％ vs 10.0％),but there was no statistical difference between the two groups (P＞0.05).The gastrointestinal adaptation time of patients in the PBEN group was significantly shorter than that in the IPEN group [(7.8±1.3) h vs (9.1±2.0) h,t=-2.334,P=0.027].The 7-day enteral nutrition compliance rate showed no significant difference between the two groups(P＞0.05).Conclusions Diarrhea was the main complication in the PBEN group and abdominal distension was the main complication in the IPEN group for post-pyloric feeding critical ill patients.Peptide-based enteral nutrition could repair the intestinal barrier function of post-pyloric feeding critical ill patients and increase the adaptability of gastrointestinal tract in the initial stage of enteral nutrition.