早期肠内肠外联合营养的不同比例对慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者的应用效果分析

Effect of different proportion of early enteral and parenteral nutrition on patients with chronic obstructive pulmonary disease combined with typeⅡrespiratory failure

目的探讨早期肠内肠外联合营养的不同比例对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并Ⅱ型呼吸衰竭患者的应用效果。方法选取2019年1月至2020年1月首都医科大学宣武医院收治的105例COPD合并Ⅱ型呼吸衰竭患者为研究对象,采用随机数字表法将其分为低比例组、中比例组和高比例组,每组各35例,均给予常规治疗和早期肠内肠外联合营养支持治疗,三组患者肠内肠外营养的热量比例分别为1∶3、1∶1、3∶1。比较三组患者治疗前后呼吸功能、睡眠质量、营养状况、肠道黏膜屏障功能和临床预后。结果三组患者治疗后10 d动脉血氧分压(arterial partial pressure of oxygen,PaO2)、前白蛋白(prealbumin,PA)、白蛋白(albumin,Alb)、总蛋白(total protein,TP)水平、第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、一秒率[FEV1/用力肺活量(forced expiratory volume,FVC)]均显著高于本组治疗前(均P<0.05),血D-乳酸、二胺氧化酶(diamine oxidase,DAO)水平、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO2)和匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分均显著低于本组治疗前(均P<0.05)。高比例组患者治疗后10 d FEV1、FEV1/FVC、PA、Alb水平均显著高于低比例组(均P<0.05),PSQI评分、血D-乳酸、DAO水平均显著低于低比例组(均P<0.05),PA水平显著高于中比例组(P<0.05),重症监护室住院天数、总住院天数均显著短于低比例组(均P<0.05)。中比例组患者治疗后10 d PA水平显著高于低比例组(P<0.05)。三组患者机械通气时间、28 d病死率和胃肠道不耐受比率比较差异均无统计学意义(均P>0.05)。结论早期肠内肠外联合营养、无创通气、抗感染、解痉等综合治疗能显著提高COPD合并Ⅱ型呼吸衰竭患者的呼吸功能、睡眠质量、营养状况与肠道黏膜屏障功能,其中3∶1的肠内肠外营养的热量比例可能是最佳选择。

Objective To investigate the effect of different proportion of early enteral and parenteral nutrition on patients with chronic obstructive pulmonary disease(COPD)combined with typeⅡrespiratory failure.Method One hundred and five COPD patients with typeⅡrespiratory failure admitted to Xuanwu Hospital,Capital Medical University from January 2019 to January 2020 were enrolled for the study and randomly divided into three groups:low proportion group,medium proportion group and high proportion group,with 35 cases in each group.They were given routine treatment and early enteral parenteral nutrition support,and the heat ratios of enteral and parenteral nutrition of the three groups were 1∶3,1∶1 and 3∶1 respectively.The respiratory function,sleep quality,nutritional status,intestinal mucosal barrier function and clinical prognosis before and after intervention were compared among the three groups.Result Ten days after treatment,the arterial partial pressure of oxygen(PaO2),prealbumin(PA),albumin(Alb),total protein(TP)levels,forced expiratory volume in one second(FEV1)and FEV1/forced expiratory volume(FVC)were all significantly higher than those before treatment(all P<0.05),the levels of blood D-lactic acid,diamine oxidase(DAO)and arterial partial pressure of carbon dioxide(PaCO2)and Pittsburgh sleep quality index(PSQI)scores were significantly lower than those before treatment(all P<0.05).Ten days after treatment,FEV1,FEV1/FVC,the levels of PA and Alb of patients in high proportion group were significantly higher than those in low proportion group(all P<0.05),the PSQI score,blood D-lactic acid and DAO levels were significantly lower than those in low proportion group(all P<0.05),the PA level was significantly higher than that in middle proportion group(P<0.05),and the intensive care unit days and total hospital days were significantly shorter than those in low proportion group(all P<0.05).Ten days after treatment,the PA level in medium proportion group was significantly higher than that in low proportion group(P<0.05).There were no significant differences in the duration of mechanical ventilation,28-day mortality rate and gastrointestinal intolerance rate among the three groups(all P>0.05).Conclusion Compre hensive treatment including early enteral and parenteral nutrition,noninvasive ventilation,anti-infection and spasmolysis can signifi cantly improve the respiratory function,sleep quality,nutritional status and intestinal mucosal barrier function of patients with COPD patients combined with typeⅡrespiratory failure,and the 3∶1 ratio of enteral and parenteral nutrition calories may be the best choice.