高脂低糖肠内营养支持对慢性阻塞性肺疾病机械通气患者通气功能及免疫功能的影响

Effect of high fat and low sugar enteral nutrition support on immune function and ventilatory function of patients with chronic obstructive pulmonary disease undergoing mechanical ventilation

目的探讨高脂低糖肠内营养支持对慢性阻塞性肺疾病(COPD)机械通气患者通气功能及免疫功能的影响。方法采用简单随机抽样法,将2018年1月至2019年12月在诸暨市人民医院治疗的COPD患者96例分为观察组和对照组各48例,对照组给予传统营养液支持治疗,观察组采用高脂低糖肠内营养支持。两组均连续治疗14 d,观察两组患者治疗前后血气分析、呼吸功能、免疫功能指标及脱机时间、脱机成功率。结果观察组治疗后动脉血氧分压(PaO2)[(10.08±0.49)kPa]、血氧饱和度(SpO2)[(96.46±2.15)%]均高于对照组的(9.53±0.46)kPa、(95.04±2.08)%(t=5.670、3.289,均P<0.05),二氧化碳分压(PaCO2)[(6.42±0.27)kPa]低于对照组的(7.33±0.25)kPa(t=17.134,P<0.05)。观察组治疗后肺活量(FVC)[(3.03±0.52)L]、第1秒用力呼气容积(FEV1)[(1.61±0.33)L]、呼吸峰值流速(PEF)[(0.54±0.08)]均高于对照组的(2.78±0.45)L、(1.42±0.31)L、(0.49±0.07)(t=2.519、2.907、3.259,均P<0.05)。观察组治疗后免疫球蛋白G(IgG)[(12.45±1.32)g/L]、免疫球蛋白M(IgM)[(1.88±0.34)g/L]、免疫球蛋白A(IgA)[(2.68±0.47)g/L]均高于对照组的(11.66±1.28)g/L、(1.65±0.37)g/L、(2.38±0.45)g/L(t=2.977、3.171、3.194,均P<0.05)。观察组患者脱机时间[(6.94±1.55)d]短于对照组的(8.73±1.41)d(t=5.919,P<0.05);观察组脱机成功率(91.67%)高于对照组(72.92%)(χ^2=5.790,P<0.05)。结论高脂低糖肠内营养支持能改善COPD机械通气患者通气指标及免疫功能指标,缩短机械通气时间,提高患者脱机成功率。

Objective:To explore the effect of high fat and low sugar enteral nutrition support on ventilatory function and immune function in patients with chronic obstructive pulmonary disease(COPD)undergoing mechanical ventilation.Methods:From January 2018 to December 2019,96 COPD patients treated in Zhuji People's Hospital were divided into observation group and control group by simple random sampling method,with 48 cases in each group.The control group was treated with traditional nutrient solution,and the observation group was given high fat and low sugar enteral nutrition.The blood gas analysis,respiratory function,immune function,weaning time and weaning success rate were observed before and after treatment.Results:After treatment,the arterial oxygen partial pressure(PaO 2)[(10.08±0.49)kPa],the blood oxygen saturation(SpO 2)[(96.46±2.15)%]in the observation group were higher than those in the control group[(9.53±0.46)kPa,(95.04±2.08)%](t=5.670,3.289,all P<0.05),and the carbon dioxide partial pressure(PaCO 2)[(6.42±0.27)kPa]was lower than that in the control group[(7.33±0.25)kPa](t=17.134,P<0.05).After treatment,the forced vital capacity(FVC)[(3.03±0.52)L],forced expiratory volume in one second(FEV 1)[(1.61±0.33)L],peak expiratory flow(PEF)(0.54±0.08)in the observation group were higher than those in the control group[(2.78±0.45)L,(1.42±0.31)L,(0.49±0.07)](t=2.519,2.907,3.259,all P<0.05).The immunoglobulin G[(12.45±1.32)g/L],immunoglobulin M[(1.88±0.34)g/L]and immunoglobulin A[(2.68±0.47)g/L]in the observation group were higher than those in the control group[(11.66±1.28)g/L,(1.65±0.37)g/L,(2.38±0.45)g/L](t=2.977,3.171,3.194,all P<0.05).The weaning time of the observation group was(6.94±1.55)d,which was lower than that of the control group[(8.73±1.41)d](t=5.919,P<0.05).The success rate of weaning of the observation group(91.67%)was higher than that of the control group(72.92%)(χ^2=5.790,P<0.05).Conclusion:High fat and low sugar enteral nutrition support can improve the ventilation indicators and immune function indicators of COPD patients with mechanical ventilation,shorten the time of mechanical ventilation,and improve the success rate of weaning.