COPD合并呼吸衰竭患者营养状态的临床研究

The Nutritional Status and Immune Function of Patients with Chronic Obstructive Pulmonary Disease and Respiratory Insufficiency

营养不良常见于慢性阻塞性肺病(CAPD)患者。观察47例COPD呼吸衰竭患者的有关营养指标。结果显示:治疗前两组体重均低于理想体重(IBW),血清蛋白低于正常值,支链氨基酸(BCAA)/芳香族氨基酸(AAA)下降,TLC和CD_4/CD_8降低。急性期前白蛋白(PALB)和a_1-AT呈正相关(r=0.386,P<0.05)。经2周营养治疗后,上述指标营养组较常规组改善明显。提示:COPD呼吸衰竭患者存在着营养不良,营养不良影响了免疫功能和呼吸肌功能。营养治疗能改善COPD呼吸衰竭患者的预后。

Malnutrition is common in patients with chronic obstructive pulmonary disease(GOPD). The anthro-pometric measurements,serum biochemical testing,serum free aminoacid,immune function and lung function were observed in 47 COPD patients. The results showed that: The mean weight of study group and control group were significantly lower than IBW values on admission(P<0.05). The level of serum protein was lower than the normal value. The level of serum free aminoacid in some patients was higher. The value of branch-chain aminoacid (BCAA)/aromatic aminoacid (AAA) was lower than the normal value. Blood todal lymphocyte count(TLC),T-lymphocyte subsets CD4/CD8 were significantly lower than the normal values( P < 0.05). There was a positive correlation between pre-acute-stage albumin (PALB) and α1-AT(r = 0.368, P< 0.05) during exacerbation stage. The malnourished patients had lower cellular immune function and decreased respiratory muscle function. Malnutrition is a risk factor in COPD prognosis. When patients were treated with parenteral nutrition, their clinical status was improved in COPD and respiratory insufficiency. The nutritional support of critically ill patients was discussed in detail.