肠内营养液对COPD患者治疗的效果观察

Therapeutic effects of long-term enteral nutrient solution on the acute attack of chronic obstructive pulmonary disease

目的探讨长期应用肠内营养液治疗对慢性阻塞性肺疾病急性发作(AECOPD)患者的作用。方法将70例需无创呼吸机辅助呼吸的AECOPD患者分为观察组和对照组,每组35例。2组患者给予一般平喘、抗感染、气道管理等常规治疗后,观察组患者给予营养支持(EN),肠内营养液3个月,对照组予以一般饮食治疗。观察对比2组患者治疗前后体重指数(BMI)、血清总蛋白(TP)、血清白蛋白(ALB)、血气PO2、PCO2、无创通气应用时间、有创通气比率、再入院比率、肺动脉压力、右心室内径等指标。结果观察组患者治疗前体重指数(21.02±2.31)kg/m^2,血清白蛋白(33.87±2.89)g/L,PO2(52.01±1.85)mm Hg,总蛋白(60.24±1.85)g/L,右心室内径(22.5±2.8)mm,PCO2(49.23±8.01)mm Hg,肺动脉压力(28.24±5.87)mm Hg。对照组患者治疗前体重指数(20.98±2.51)kg/m^2,血清白蛋白(34.12±2.97)g/L,PO2(52.27±1.67)mm Hg,总蛋白(60.78±1.57)g/L,右心室内径(21.8±3.1)mm,PCO2(50.04±7.77)mm Hg,肺动脉压力(27.94±6.11)mm Hg。2组患者治疗前各指标比较均无明显差异(P>0.05)。观察组患者治疗后体重指数(24.57±3.52)kg/m^2,血清白蛋白(37.28±1.98)g/L,PO2(89.89±3.87)mm Hg,总蛋白(64.87±2.87)g/L,右心室内径(15.32±2.9)mm,PCO2(36.17±2.07)mm Hg,肺动脉压力(22.10±4.55)mm Hg。对照组患者治疗后体重指数(22.58±5.78)kg/m^2,血清白蛋白(35.99±1.95)g/L,PO2(85.23±2.74)mm Hg,总蛋白(60.78±1.57)g/L,右心室内径(18.71±2.2)mm,PCO2(38.98±3.84)mm Hg,肺动脉压力(25.01±4.72)mm Hg。治疗后2组患者血清白蛋白、总蛋白、体重指数、PO2均较治疗前增高(P<0.05),治疗后肺动脉压力、右心室内径、PCO2较治疗前均有下降(P<0.05);经治疗后观察组患者血清白蛋白、总蛋白、体重指数、PO2均较对照组明显增高(P<0.05),PCO2、无创通气应用时间、有创通气比率、再入院比率、肺动脉压力、右心室内径均比对照组明显降低(P<0.05)。结论肠内营养可以有效增加COPD患者的免疫力,降低炎症反应,改善肺功能,提高治疗效果,降低再入院率,明显改善预后。

Objective To investigate the therapeutic effects of long-term enteral nutrient solution on the acute attack of chronic obstructive pulmonary disease(AECOPD).Methods Seventy patients with AECOPD who required non-invasive ventilator assisted breathing were divided into observation group and control group,with 35 cases in each group.The patients in both groups were treated by general antiasthmatic,anti-infection and other routine therapy,and the patients in observation group were treated by enteral nutrient(EN)support for 3 months,however,the patients in control group received general diet treatment.The body mass index(BMI),total serum protein(TP),serum albumin(ALB),blood gas PO2,PCO2,the duration of application of non-invasive ventilation,ratio of invasive ventilation,re-admission rate,pulmonary artery pressure,right ventricular diameter and other indexes were observed and compared between the two groups.Result Before treatment,there were no significant differences in BMI,serum albumin,PO2,total protein,right ventricular diameter and pulmonary artery pressure between observation group and control group(P>0.05).After treatment,the BMI,serum albumin,PO2,total protein,PO2 were significantly increased in both groups(P<0.05),however,the pulmonary artery pressure,right ventricular diameter,PCO2 were significantly decreased in both groups(P<0.05).After treatment the serum albumin,total protein,BMI,PO2 in observation group were significantly higher than those in control group(P<0.05),however,the PCO2 PCO2,duration of non-invasive ventilation,ratio of invasive ventilation,ratio of re-admission,pulmonary artery pressure and right ventricular diameter in observation group were significantly lowr than those in control group(P<0.05).Conclusion The enteral nutrition can effectively increase the immunity of patients with COPD,reduce inflammatory reaction,improve lung function,improve therapeutic effects,reduce readmission rate,so as to improve patient’s prognosis obviously.