肠内营养对重症COPD患者疗效和心功能的影响

Effects of enteral nutritional support on therapeutic outcomes and heart functions in patients with severe COPD

目的观察肠内营养支持对需要无创机械通气治疗的重症慢性阻塞性肺病(chronic obstructive pulmonarydiseases,COPD)患者的营养免疫状况、心功能指标以及疗效转归等的影响。方法需无创机械通气的COPD急性加重期合并营养不良患者72例,分为早期肠内营养治疗组(A组,n=38)和对照组(B组,n=34)。B组采用常规治疗,A组在常规治疗的基础上经鼻饲给予早期肠内营养支持,治疗期为2周,比较两组患者的临床疗效、血气分析、营养指标、血淋巴细胞总数(TLC)以及血清C反应蛋白(CPR)、肿瘤坏死因子-α(TNF-α)、脑钠肽(BNP)及脑钠肽前体(pro-BNP)等指标的变化。结果 A组临床疗效(好转率、机械通气时间及住院时间)和血气分析、营养状况(血清白蛋白、前白蛋白、实际体质量占理想值的百分比IBW%等)及外周血淋巴细胞总数改善情况均优于B组(P<0.05);经治疗后,A组患者血清中COPD相关炎症指标CPR、TNF-α较B组更早呈现下降趋势,pro-BNP、BNP也显著性低于B组。结论肠内营养支持治疗可有效改善重症慢性阻塞性肺病患者的营养状况,改善免疫状况,有助于及早控制COPD炎症反应,提高疗效。

Objective To assess the effects of enteral nutritional support on the nutrition and immune status,cardiac functions and therapeutic outcomes in patients with severe chronic obstructive pulmonary disease（COPD）.Methods Seventy two cases of acute exacerbation COPD complicated by malnutri-tion,who needed non-invasive mechanical ventilation,were divided into early enteral nutrition group（group A,n=38） and control group（group B,n=34）.The patients in group B accepted conventional therapy.Those in group A were treated with enteral nutrition support by nasogastric feeding for 2 weeks on the basis of conventional therapy.The clinical efficacy of two groups were compared,and the changes of blood gas analysis,nutritional parameters,blood total lymphocyte count（TLC）,serum C-reactive protein（CPR）,tumor necrosis factor-α（TNF-α）,brain natriuretic peptide（BNP） and brain natriuretic peptide precursor（pro-BNP） were compared before and after treatment in both groups.Results The patients in group A obtained better clinical efficacy（improvement rate,mechanical ventilation and length of hospital stay,blood gas analyst） and higher parameters of nutritional indexes（serum albumin,prealbumin,IBW%,etc.） and TLC in the peripheral blood than those in group B（P0.05）.After treatment,COPD-related-inflammatory markers of group A,including CRP and TNF-α,presented earlier downward trend compared with those of group B;pro-BNP/BNP were also significantly lower in group A.Conclusion For the patients with severe COPD,enteral nutrition support can be effective in improving their nutritional and immune status,control of inflammation,and improving the outcome.