肠内营养对慢性阻塞性肺疾病合并肺心病患者营养状况及心功能的影响

Effect of enteral nutrition on nutritional status and cardiac function in patients with chronic obstructive pulmonary disease complicated with pulmonary heart disease

目的观察肠内营养(EN)支持对慢性阻塞性肺疾病(COPD)合并肺心病患者营养状况、心功能指标的影响.方法选择2015年1月至2017年12月温州市中西医结合医院收治的60例COPD合并肺心病患者为研究对象,分为西医常规治疗组和EN组,每组30例.西医常规治疗组给予利尿、强心、维持水和电解质平衡、扩血管、祛痰、扩张支气管及抗感染等常规治疗;EN组在西医常规治疗基础上早期给予EN乳剂(瑞能)使热量保持在83.68~146.44 kJ/kg,两组均连续治疗4周.比较两组治疗后营养状况(血清前白蛋白、白蛋白)和心功能指标〔左室射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)〕的变化.结果两组治疗前LVEF、NT-proBNP、白蛋白、前白蛋白比较差异均无统计学意义(均P>0.05),两组治疗后LVEF、白蛋白、前白蛋白均较治疗前升高,NT-proBNP均较治疗前明显降低;且治疗后EN组LVEF、白蛋白、前白蛋白均明显高于西医常规治疗组〔LVEF:0.495±0.046比0.443±0.042,白蛋白(g/L):39.1±4.6比36.2±4.2,前白蛋白(μg/L):235.8±42.2比198.1±35.3,均P<0.05〕,NT-proBNP明显低于西医常规治疗组(μg/L:325.3±106.7比512.6±173.2,P<0.05).结论给予COPD合并肺心病患者早期EN支持,对改善患者营养状况、提高心功能有积极作用.

Objective To observe the effects of enteral nutrition(EN)support on nutritional status and cardiac function indicators in patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary heart disease.Methods The 60 patients with COPD complicated with pulmonary heart disease admitted to Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2015 to December 2017 were selected as research subjects,including Western medicine routine treatment group(30 cases)and EN group(30 cases).The Western medicine routine treatment group was treated with conventional therapy such as diuretic,cardiotonic,maintaining water and electrolyte balance,vaso-dilation,expectorant,bronchiectasis and anti-infection;EN group was treated with early EN emulsion(Ruineng)based on routine treatment,maintaining the heat at 83.68-146.44 kJ/kg.Both groups were treated continuously for 4 weeks.The changes of nutritional status(serum pre-albumin and albumin)and cardiac function indicators[left ventricular ejection fraction(LVEF)and N-terminal pro-brain natriuretic peptide(NT-proBNP)]after treatment were compared between the two groups.Results There were no significant differences in LVEF,NT-proBNP,prealbumin and albumin between two groups before treatment(all P>0.05).After treatment,the LVEF,albumin and prealbumin in two groups were higher than those before treatment,while NT-proBNP was lower than that before treatment;the levels of LVEF,prealbumin and albumin in EN group were significantly higher than those in Western medicine routine treatment group[LVEF:0.495±0.046 vs.0.443±0.042,albumin(μg/L):39.1±4.6 vs.36.2±4.2,pre-albumin(μg/L):235.8±42.2 vs.198.1+35.3,all P<0.05],and NT-proBNP was significantly lower than that in Western medicine routine treatment group(pg/L:325.3±106.7 vs.512.6±173.2,P<0.05).Conclusion Early EN support for COPD patients complicated with pulmonary heart disease has energetic action to improve their nutritional status and elevate their cardiac function.