营养支持治疗对COPD患者生活质量和功能状态的影响

Effect of Nutritional Therapy on Quality of Life and Functional Status of Patients with Chronic Obstructive Pulmonary Disease

目的探讨营养支持治疗配合常规治疗对重度、极重度慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)稳定期患者的效果。方法选取120例重度、极重度COPD患者为研究对象,且患者同时表现出有营养不良或营养不良风险(MNA-SF≤11分),按照随机数字表法分为对照组与观察组,各60例;对照组给予劝导戒烟、氧疗、药物使用等常规治疗,观察组在此基础上给予基柔[β-羟基-β-甲基丁酸盐(β-hydroxy-β-methlyl butyrate,HMB)配方]、全营养粉及营养专家精准饮食指导等营养支持治疗。分别在干预前与干预后(营养支持治疗12周后)比较2组患者的肺功能指标[第1秒用力呼气容积(FEV1)占预计值%及用力肺活量(FVC)]、最大吸气压力(MIP)、最大呼气压力(MEP)、膈肌厚度及移动度、左右手握力(HGS)、6 min步行距离(6MWD)、COPD患者自我评估测试问卷(CAT)评分、改良版英国医学研究委员会呼吸问卷(mMRC)评分、体质量指数(BMI)和去脂体质量指数(FFMI)等指标。结果干预前2组BMI、FFMI、CAT、膈肌活动度、FEV1占预计值%、MIP、FVC、左右手HGS比较,差异无统计学意义(P>0.05);干预后,观察组BMI(22.2±2.7)kg·m^(-2)、FFMI(19.5±1.9)kg·m^(-2)、CAT(11.9±4.5)分、膈肌活动度(1.29±0.33)cm、FEV1占预计值%(41.7±6.4)%、MIP(49.7±10.1)cmH2O、FVC(2.29±0.27)L、左HGS(36.5±8.6)kg、右HGS(38.2±8.6)kg,对照组BMI(21.1±2.5)kg·m^(-2)、FFMI(18.7±1.7)kg·m^(-2)、CAT(16.6±6.1)分、膈肌活动度(1.14±0.32)cm、FVE1占预计值%(38.1±5.5)%、MIP(45.3±10.6)cmH2O、FVC(2.19±0.18)L、左HGS(31.4±4.7)kg、右HGS(33.9±5.5)kg,观察组各指标均优于对照组,差异有统计学意义(P<0.05)。结论HMB、精准营养支持联合药物治疗可以降低重度、极重度COPD患者的营养不良风险,提高其生活质量及功能状态,加快患者康复。

Objective The purpose of this study is to investigate the effect of nutritional support combined with routine therapy on patients with severe and very severe chronic obstructive pulmonary disease(COPD)in stable stage.Methods 120 patients with severe and very severe COPD were selected as the research objects,and the patients showed malnutrition or malnutrition risk(MNA-SF≤11 points).They were randomly divided into control group and observation group,60 cases in each group.The control group was given conventional treatment such as smoking cessation,oxygen therapy and standardized drug use,while the observation group was given nutrition support treatment such as basic soft,total nutrition powder and nutrition expert precise diet guidance.The pulmonary function(FEV1 and FVC),maximal inspiratory pressure(MIP),maximal air pressure(MEP),diaphragm thickness and mobility,handgrip strength(HGS),and six-minutes walk distance(6MWD)were analyzed before treatment and 12 weeks after nutritional support treatment,the modified MRC breathing questionnaire(mMRC),body mass index(BMI)and lipid-free body mass index(FFMI)were used to assess symptoms and self-assessment questionnaire(CAT)of COPD patients.Results Before intervention,there was no statistically significant difference in BMI,FFMI,CAT,diaphragm activity,forced expiratory volume in the first second(FEV1),MIP,forced vital capacity(FVC),and left and right HGS;After the intervention,the observation group BMI(22.2±2.7)kg·m^(-2),FFMI(19.5±1.9)kg·m^(-2),CAT(11.9±4.5)points,diaphragm activity(1.29±0.33)cm,FEV1(41.7±6.4)%,MIP(49.7±10.1)cmH2O,FVC(2.29±0.27)L,left HGS(36.5±8.6)kg,right HGS(38.2±8.6)kg,the control group BMI(21.1±2.5)kg·m^(-2),FFMI(18.7±1.7)kg·m^(-2),CAT(16.6±6.1)points,diaphragm activity(1.14±0.32)cm,FVE1(38.1±5.5)%,MIP(45.3±10.6)cmH2O,FVC(2.19±0.18)L,left HGS(31.4±4.7)kg,right HGS(33.9±5.5)kg,all indicators of the observation group are better than those of the control group,and the difference was statistical significance(P<0.05).Conclusion HMB,precision nutritional support combined with drug therapy can reduce the risk of malnutrition in patients with severe and very severe chronic obstructive pulmonary disease,improve their quality of life and functional status,and speed up the recovery of patients.