短期营养支持对COPD呼吸衰竭合并严重营养不良患者的作用

Short-Term Nutritional Support in Treating COPD and Respiratory Insufficiency with Severely Malnutrition

目的 评价COPD呼吸衰竭合并营养不良患者的营养状态及短期营养支持的疗效。方法 研究 2 7例住院的COPD呼吸衰竭伴严重营养不良患者的营养状态 ,将患者随机分为胃肠外 (PN)组及非胃肠外营养(NPN)组 ,给予为期两周的胃肠外营养支持。结果 (1)人体测量 :营养支持两周后 ,PN组体重由 (42 .6± 7.0 )kg增加至 (46 .0± 5 .6 )kg(P <0 .0 5 ) ,体重增加 1.6～ 3.4kg ,而NPN组无显著性变化 ;PN组的TSF、MAMC显著增加 (P <0 .0 5 ) ;(2 )生化检查 :营养支持两周后 ,PN组的TRF、PALB及CHI%pred显著性增加 (P <0 .0 5 ) ,且与NPN组有显著性差异 (P <0 .0 5 ) ;(3)免疫功能 :营养支持两周后 ,PN组的血TLC、PPD阳性率及CD4 /CD8显著性增高 (P <0 .0 5 ) ,且与NPN组有显著性差异 (P <0 .0 5 )。

Purpose: To assess the nutritional status of chronic obstructive pulmonary disease (COPD) and respiratory insufficiency patients with malnutrition. Methods: We studied the nutritional status with anthropometric measurements, serume and urinary biochemical testing, immune function. 27 moderate or severe malnourished patients with COPD and respiratory insufficiency were randomized to a parenteral nutrition(PN) group or a non-parenteral nutrition (NPN) group, studied again two weeks after PN support. Results: (1)Anthropometric measurement: two weeks of PN support later, the mean weight of PN group increased from (42.6 ± 7.0) to (46.0 ± 5.6) kg (P < 0.05), the range of weight gain was 1.6 to 3.4 kg, but the mean weight of NPN group did not significantly altered. Two weeks of PN support later, TSF, MAMC values of PN group were significantly increased (P < 0.05). (2)Biochemical testing: two weeks of PN support later, serum TRF, PALB and CHI% pred of PN group were significantly increased(P < 0.05), and significantly higher than those of NPN group(P < 0.05). (3) Immune function: two weeks of PN supporlater, blood TLC, percentage of PPD positive, ratio of CD4/CD8 were significantly increased(P < 0.05), and significantly higher than those of NPN group(P < 0.05). Conclusions: Short-term nutritional support can improve the nutritional status of the patients of COPD and respiratory insufficiency with malnutrition.