不同胃残留量COPD机械通气患者肠内营养耐受性的影响因素分析

Influential Factors of the Tolerance of Enteral Nutrition in COPD Patients with Different Gastric Residual Volume

【目的】观察影响胃残留量（GRV）小于250ml的慢性阻塞性肺疾病（COPD）患者早期进行肠内营养（EN）时影响耐受性的因素。【方法153例COPD机械通气患者，在EN治疗前检测患者GRV，ApacheⅡ评分、外周血胃动素（MTL）、二胺氧化酶（DAO）水平，并观察接受治疗后的耐受性。【结果】GRV≤150mL的21例，不耐受6例（28．8％），GRV〉150mL的32例，不耐受8例（25．0％），两组间无统计学差异（P〉0．05）；耐受组患者的年龄、ApacheⅡ评分、血浆DAO、MTL水平均显著低于不耐受组（P〈0．05）。【结论】疾病的严重程度和高龄是影响cOPD患者机械通气早期EN耐受性的重要因素，GRV150mL以内与150～250mL间对EN耐受性的影响差别不明显。

[Objective]To observe the factors affecting the tolerance of patients with chronic obstructive pulmonary disease（COPD） by early enteral nutrition（EN） whose gastric residual volume（GRV） is less than 250 mL. [Methods] GRV, ApacheII score, MTL and DAO level in peripheral blood of patients before EN treatment were detected. The tolerance after treatment was observed. [Results] There was 6 patients with intolerance in 21 patients with GRV≤150 mL and 8 patients with intolerance in 32 patients with GRV〉150mL, and there was no significant difference between the two groups. However, there were significant differences in age, Apachell score and plasma MTL and DAO levels between tolerance group and intolerance group（ P 〈0.05）. [Conclusion] The severity of disease and advanced age are the important factors that affect the tolerance of COPD patients by early EN and mechanical ventilation. There is no obvious difference of the tolerance in patients with GRV less than 150ml or between 150-250 mL.