呼吸内科重症监护病房慢性阻塞性肺疾病机械通气患者应用早期肠内外营养的效果

Effects of Early Enteral and Enteral Nutrition on Mechanical Ventilation Patients with Chronic Obstructive Pulmonary Disease in the Respiratory Intensive Care Unit

目的:探讨呼吸内科重症监护病房慢性阻塞性肺疾病(COPD)机械通气患者应用早期肠内外营养的效果。方法:选取中国人民解放军北部战区总医院2018年4月-2020年4月行机械通气治疗的重症COPD患者86例,将其随机分为对照组和研究组,每组43例。对照组实施常规肠内外营养支持,研究组实施早期肠内外营养支持。比较两组基线资料、免疫指标、营养指标,比较两组撤机时、撤机后2 h通气指标,比较两组再插管率、住院时间、有创机械通气时间、呼吸机相关性肺炎(VAP)发生率。结果:研究组治疗14 d的IgM、IgG、IgA、TRF均高于对照组(P<0.05),研究组治疗30 d的IgM、IgG、IgA、TRF、PAB、ALB均高于对照组(P<0.05)。撤机时,两组BE、PaCO;、PaO;、pH比较,差异均无统计学意义(P>0.05),研究组RSBI低于对照组(P<0.05);撤机后2 h,研究组CO;潴留率、PaCO;均低于对照组(P<0.05)。两组再插管率、住院时间、有创机械通气时间、VAP发生率比较,差异均无统计学意义(P>0.05)。结论:COPD患者行机械通气治疗时实施早期肠内外营养支持,可改善患者机体营养状态、免疫功能及撤机时、撤机后的呼吸肌疲劳状态,是患者治疗成功的重要措施,具有一定临床意义,值得推广。

Objective: To investigate the effect of early enteral and enteral nutrition on mechanical ventilation patients with chronic obstructive pulmonary disease(COPD) in respiratory intensive care unit.Method: A total of 86 patients with severe COPD who received mechanical ventilation in General Hospital of the Northern Theater of the Chinese People’s Liberation Army from April 2018 to April 2020 were selected and randomly divided into control group and study group, 43 cases in each group. The control group received routine enteral and parenteral nutrition support, and the study group received early enteral and parenteral nutrition support.The baseline data, immune indexes and nutritional indexes of the two groups were compared, and the ventilation indexes of the two groups during and 2 h after withdrawal were compared, the reintubation rate, length of hospital stay, duration of invasive mechanical ventilation and incidence of ventilator-associated pneumonia(VAP) were compared between the two groups. Result: The levels of IgM, IgG, IgA and TRF in the study group were higher than those in the control group at 14 d for treatment(P<0.05), and the levels of IgM, IgG, IgA, TRF, PAB and ALB in the study group at 30 d for treatment(P<0.05). There were no significant differences in BE, PaCO;, PaO;and pH between the two groups during with drawal(P>0.05), RSBI in the study group was lower than that in the control group(P<0.05).The CO;retention rate and PaCO;in the study group were lower than those in the control group at 2 h after withdrawal(P<0.05). There were no significant differences in reintubation rate, length of hospital stay, duration of invasive mechanical ventilation and incidence of VAP between the two groups(P>0.05). Conclusion: The implementation of early enteral and parenteral nutrition support for COPD patients undergoing mechanical ventilation treatment can improve the nutritional status and immune function of patients, as well as the fatigue state of respiratory muscles during and after the withdrawal of mechanical ventilation, which is an important measure for successful treatment of patients, has certain clinical significance and is worth promoting.