个体化营养支持对重度慢性阻塞性肺疾病急性加重期患者的疗效观察

Individualized Nutritional Supplementation in Patients with Acute Exacerbation of Severe Chronic Obstructive Pulmonary Disease

目的:探讨个体化营养支持对重度慢性阻塞性肺疾病急性加重期患者的疗效。方法:前瞻性选取2015年1-12月于我院呼吸内科住院诊断为重度慢性阻塞性肺疾病患者166例,采用随机数字表法分为两组,在抗感染、舒张气道及对症治疗基础上,观察组(86例)精确计算每位患者每日能量需求,经肠内或肠外补充;对照组(80例)不给予饮食干预。观察两组治疗前、后血清总蛋白、前白蛋白、白蛋白、尿素氮、血气分析、FEV1%pred、BODE指数及住院天数的差异。结果:观察组治疗后血清总蛋白、前白蛋白、白蛋白均较治疗前升高(P<0.05),且较对照组明显升高(P<0.05),两组间血清尿素氮水平较治疗前无明显变化。观察组PaO_2治疗后较治疗前明显升高,PaCO_2较治疗前明显降低,且均较对照组改变明显(P<0.05)。观察组FEV1%pred较治疗前明显升高,而对照组无明显变化。两组间BODE指数较治疗前明显降低,但观察组改善更为明显。观察组平均住院天数为(10.68±2.44)d,明显短于对照组的(12.49±2.22)d(P=0.002)。结论:个体化营养支持有利于慢性阻塞性肺疾病急性加重期患者病情恢复,缩短住院时间,值得临床上应用及推广。

Objective：To explore the efficiency of individualized nutritional supplementation（INS）in patients with acute exacerbation of severe chronic obstructive pulmonary disease（COPD）.Methods：166patients with acute exacerbation of severe COPD admitted in our hospital from Jan to Dec 2015 were were randomly divided into two groups：observation group（86cases）and control group（80cases）.The two groups were all given conventional therapy,bisdes,the daily energy requirement of patients in observation group were accurately calculated and given by enteral nutrition or parenteral nutrition,while,no dietary intervention were given in control group.The differences in serum total protein,prealbumin,albumin,blood urea nitrogen,blood gas analysis,FEV1%pred,BODE index and average hospitalization days between the two groups were analyzed.Results：The level of serum total protein,prealbumin and albumin in observation group were significantly improved after INS,the improvements were relatively higher than control group,but no significantly improvements in blood urea nitrogen were observed.The PaO2 were significantly increased after INST and the PaCO2 were significantly decreased in observation group,and the improvements were relatively higher than control group（P0.05）.The FEV1%pred was significantly improved after INST,but no significantly improvement was observed in control group.The BODE indexes were significantly decreased in two groups but obvious improvements were observed in observation group after INST.The average hospitalization days in observation group were（10.68±2.44）days and significantly shorter than control group（12.49±2.22）days（P=0.002）.Conclusion：The individualized nutritional supplementation treatment can improve the rnutritional status,pulmonary function in patients with acute exacerbation of severe COPD,and can reduce the average hospitalization days,and was worthy of widely promoted.