高能低糖肠内营养液改善机械通气COPD患者的临床疗效

Clinical Effect of Enteral Nutrient Solution in Improving Chronic Obstructive Pulmonary Disease Patients under Mechanical Ventilation

目的 观察高脂肪（50％）、低碳水化合物（32％）肠内营养液对机械通气慢性阻塞性肺疾病（COPD）患者的临床疗效。方法 我院32例机械通气COPD患者，平均年龄（70．4±17．4）岁，体重为（45．4±6．6）kg，均明显低于正常值（P〈0．01）；并伴有明显的营养不良。随机分为高能低糖肠内营养组（n=18）和传统肠内营养组（n=14）。两组均采用鼻饲肠内营养支持，每天供给热能125kJ（30kcal）/kg。蛋白质0．8～1．0g/kg，热氮比值为627.6kJ比1g。分别于营养治疗前一天及治疗后第10天测定血常规、电解质、呼吸商（RQ）、每分钟通气量（VE）、二氧化碳生成量（VCO2）、氧耗量（VO2）、二氧化碳分压（PaCO2）、氧分压（PaO2）、pH值以及血清总蛋白、白蛋白、血红蛋白、淋巴细胞比例等指标。结果治疗前两组患者的各项指标测定值相近，治疗10天后高能低糖组患者的VE、VCO2、VO2、RQ均较传统营养组显著降低（P〈0．05）。传统营养治疗前后VE、VCO2、VO2、RQ无明显变化。两组患者的血气分析均有不同改善，高能低糖肠内营养组的PaCO2较传统肠内营养组降低，PaO2增高，但两组的差异无显著性。两组血液生化和血常规结果均无显著差异。结论 高能低糖营养制剂能降低VCO2和RQ，减少VE和VO2，对于失偿期COPD患者有明显的临床治疗效果。

Objective To observe the clinical effect of high-fat （50%） and low-carbohydrate （32%） enteral nutrient solution （ENS） administered to chronic obstructive pulmonary disease （COPD） patients under mechanical ventilation. Methods A total of 32 COPD patients under mechanical ventilation in our hospital, with a mean age of （70.4 ± 17.4） years, were chosen. Their mean body weight was （45.4 ± 6.6） kg, which was significantly lower than the normal values （ P 〈 0.01 ）. Obvious malnutrition was observed. The patients were divided into high-fat and low-carbohydrate enteral nutrient solution group （HL group, n = 18 ） and traditional enteral nutrient solution group （control group, n = 14）. All patients in both two groups were nasally fed with intestinal nutrition, which contained 125 kJ （30kcal） /kg energy and 0.8-1.0 g/kg proteins, and the ratio of the calorie to nitrogen was 627.6. The blood routine examination, electrolytes analysis, as well as RQ, VE, VCO2, VO2, and blood gas analysis （PaCO2, pH value） were performed; indicators such as total serum protein, albumin, haemoglobin, and lymphocytes ratio were separately determined one day before nutritional support and ten days after nutritional support. The improvement of pulmonary ventilation and the changes of VCO2, VO2, and blood gas （PaO2, PaCO2, pH value） were observed. Results The baseline indicators were similar before nutritional supports. Ten days after nutritional supports, VE, VCO2, VO2, and RQ were all significantly lower in HL group than control group （P 〈 0.05）. No significant changes in VE, VCO2, VO2, and RQ were observed in control group. The blood gas in the two groups were more or less improved; PaCO2 was lower in the HL group than in control group, while PaO2 was higher in HL group; however, such differences had no statistical significance. No significant differences were observed in blood biochemical examination and blood routine examination. Conclusion High-fat and low-carbohydrate ENS can decrease VCO2, RQ, VE, and VO2, and thus exerts a beneficial effect on the COPD patients under decompensatory stage.