三种营养支持治疗高龄心力衰竭并发肾功能不全患者疗效的比较

Effect of three types of nutrition therapy on elderly patients with heart failure complicated by renal insufficiency

目的:观察和比较肠内肠外联合营养、单纯肠内营养、单纯肠外营养3种营养支持方法对高龄心力衰竭并发肾功能不全患者疗效的影响及安全性。方法:入选86例急性心力衰竭并发肾功能不全患者,随机分为3组:肠内肠外联合营养组(联合组,33例),肠内营养组(肠内组,27例),肠外营养组(肠外组,26例)。采用随机、开放、无安慰剂对照、无长期随访和预后终点的方法采集和统计信息,3组营养支持后7 d,进行临床疗效分析和安全性评价。结果:同组治疗前后比较,血清白蛋白(ALB)、前白蛋白(PAB)、转铁蛋白(TF)、N末端B型钠尿肽原(NT-proBNP)下降,均有统计学意义(P<0.05),联合组与肠内组、肠外组治疗后比较,PAB、ALB、TF、NT-proBNP均有统计学意义(P<0.05),肠内组与肠外组治疗后比较,PAB、ALB、TF、NT-proBNP均无统计学意义。3组治疗前及治疗后肌酐无显著差异。与治疗前比较,3组治疗后每搏输出量(SV)、左室射血分数(LVEF)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)均显著改善(P<0.05);联合组治疗后较肠内组、肠外组改善更显著(P<0.05);肠内组与肠外组治疗后比较无统计学差异。3组临床症状改善率和不良事件发生率均无显著差异。结论:对于高龄心衰并发肾功能不全的患者,联合营养支持的近期疗效显著优于单独肠内营养支持和肠外营养支持。

Abstract AIM： To explore and compare the efficacy and safety of enteral nutrition （EN） , parenteral nutrition （ PN）, and EN ＋ PN in treatment of elderly patients of heart failure complicated with renal insufficiency. METHODS ： A total of 86 patients with refractory heart failure complicated by renal insuf- ficiency was randomly allocated into three groups： EN ＋ PN （33 cases）, EN group （27 cases） and PN group （26 cases）. We used a randomized, open, non-placebo-controlled treatment design without long- term follow-up. Clinical efficacy and safety were compared. RESULTS： After treatment, serum albumin （ALB）, pre-albumin （PAB）, transferrin （TF） and amino terminal B-type natriuretic peptide precursor （NT-proBNP） decreased significantly （P 〈0. 05）. Compared with those in EN group and PN group, the decrease of ALB, PAB, TF and NT-proBNP in EN ＋ PN group was significant （ P 〈 0.05 ）. After treat- ment, no significant differences were found between EN group and PN group. No significant difference was found in creatinine （Cr） before and after treatment in the three groups. Stroke volume （SV）, left ventricular ejection fraction （LYEF）, left ventricular end-diastolic dimension （LVEDD） and left ventricular end-systolic diameter （LVESD） improved significantly in the three groups （P 〈 0. 05 ）, with signifi- cant difference between EN ＋ PN group and the other two groups but no significant difference between EN group and PN group. Clinical symptoms improvement and severe adverse event rates were similar in the three groups. CONCLUSION： EN ＋ PN produces much better short-term effects than EN or PN alone for elderly patients with heart failure complicated by renal insufficiency.