不同营养支持方式对AECOPD患者营养状态影响的研究

Effects of Differential Kinds of Nutritional Support Therapy on Nutritional Status in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:探讨不同营养支持方式对慢性阻塞性肺疾病急性加重期(AECOPD)患者营养状态的临床研究。方法:随机选取556例AECOPD患者进行回顾性分析,其中肠内营养(EN)组36例、肠内联合肠外营养(EN+PN)组45例、肠外营养(PN)组201例、对照组274例。对照组给予常规治疗,营养支持组在此基础上分别给予不同的营养支持方式,比较4组患者治疗前后营养、免疫、肝肾功能指标变化。结果:(1)营养及免疫状态:治疗后各营养支持组患者总蛋白、前白蛋白、血红蛋白均较对照组明显升高(P<0.05),PN组白蛋白、淋巴细胞数均较对照组明显升高(P<0.05);治疗后PN组血红蛋白较EN组升高(P<0.05);治疗后EN组、EN+PN组总蛋白均较PN组升高(P<0.05)。(2)肝肾功能:治疗后PN组丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌酐(CR)均较对照组明显增高(P<0.05),治疗后EN+PN组CR较对照组明显增高(P<0.05),各营养组尿素氮(BUN)较对照组改善不明显(P>0.05)。结论:在常规治疗基础上应用营养支持治疗可以明显改善AECOPD患者的营养状态,肠外营养对患者肝肾功能有一定的影响。

Objective：To detect effects of differential kinds of nutritional support therapy on nutritional status in patients with acute exacerbation of chronic obstructive pulmonary disease.Methods：556 patients with AECOPD selected randomly were retrospectively ana-lyzed, including enteral nutrition （EN） group （36 cases）, enteral combined parenteral nutrition （EN＋PN） group （45 cases）, paren-teral nutrition （ PN） group （201 cases） , control group （274 cases）.The control group received conventional therapy, nutritional support group on this basis were given different nutritional support.The nutritional status, immunization, liver and kidney function indicators change before and after comparison of the four groups treated were observed.Results：（1） Nutrition and immune status：After treatment, the total protein, pre-albumin, hemoglobin of every nutritional support group significantly higher than the control group （P〈0.05）, in PN group the albumin and lymphocyte count than the control group was significantly higher （ P〈0.05 ）; after treatment compared with PN group hemoglobin in EN group increased （P〈0.05）;after treatment, EN and EN＋PN group increased total protein compared with PN group （ P〈0.05）.（2） Liver and kidney function：For PN group after treatment ALT, AST, and CR was significantly higher than the control group （P〈0.05）, CR for EN＋PN group was significantly higher than the control group （P〈0.05）, for each nutritional group BUN obvious improvement than the control group （P＆gt;0.05）.Conclusion： The nutritional support can improve the nutritional status of patients with AECOPD, the PN has some effects on liver and kidney function.