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型呼吸衰竭患者的影响

Effect of different proportions of enteral parenteral nutrition on patients with early-stage chronic obstructive pulmonary disease complicated with respiratory failure type Ⅱ

目的 通过对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者施行不同热量比例的早期肠内肠外联合营养,探讨早期肠内肠外联合营养的不同比例对患者临床治疗效果及预后影响。方法 选取上海市第十人民医院2019年2月-2021年2月收治的COPD合并Ⅱ型呼吸衰竭患者108例为研究对象,根据随机数字表法随机分为低、中、高比例组各36例。3组在常规治疗基础上分别给予肠内与肠外热量比为1∶3、1∶1、3∶1的联合营养支持。比较3组治疗前后呼吸功能、营养状况、胃肠道黏膜屏障功能和临床预后情况。结果 治疗10 d后,3组患者呼吸功能、营养状况、胃肠道黏膜屏障功能相关指标均较治疗前明显改善(均P<0.05);高比例组PaO2、用力肺活量、一秒率、ALB、前白蛋白(PA)、转铁蛋白(TRF)显著高于中、低比例组(均P<0.05);D-乳酸、二胺氧化酶、前降钙素显著低于中、低比例组(均P<0.05);高比例组PaCO_(2)显著低于低比例组(P<0.05),中比例组ALB、PA、TRF显著高于低比例组(均P<0.05);高比例组机械通气时间、ICU住院时间、总住院时间显著低于低比例组(均P<0.05);3组28 d病死率(13.8%、8.33%、3.56%)比较差异无统计学意义(χ^(2)=1.543;P=0.462)。结论 早期肠内肠外联合营养能有效提高COPD合并Ⅱ型呼吸衰竭患者的呼吸功能、营养状况和肠道黏膜屏障功能,改善预后,其中肠内肠外营养热量比例为3∶1的联合营养方案效果最优。

Objective To perform early enteral and parenteral nutrition with different calorie ratios in patients with chronic obstructive pulmonary disease(COPD) and type Ⅱ respiratory failure, and explore the impact of different proportions of early enteral and parenteral nutrition on the clinical treatment effect and prognosis of patients. Methods A total of 108 patients with COPD combined with type Ⅱ respiratory failure admitted to the 10th People’s Hospital of Tongji University from February 2019 to February 2021 were selected and randomly divided into low, medium and high proportion groups, with 36 cases in each group according to random number table method. On the basis of conventional treatment, the three groups were given combined nutritional support with enteral and parenteral calorie ratios of 1∶3, 1∶1 and 3∶1. Respiratory function, nutritional status, gastrointestinal mucosal barrier function and clinical prognosis of the three groups were compared before and after treatment. Results After 10 days of treatment, respiratory function, nutritional status and gastrointestinal mucosal barrier function-related indices in the three groups were significantly improved compared with before treatment(all P<0.05). PaO2, FVC, FEV1/FVC, ALB, PA and TRF in high-proportion groups were significantly higher than those in the medium-and low-proportion groups(all P<0.05). D-lactic acid, DAO and procalcitonin were significantly lower than those in the medium-and low-proportion groups(all P<0.05). PaCO_(2) in the high-proportion group was significantly lower than that in the low-proportion group(P<0.05), and ALB, PA and TRF in the medium-proportion group were significantly higher than those in the low-proportion group(all P<0.05). The mechanical ventilation duration, length of ICU stay and total length of hospital stay in the high-proportion group were significantly lower than those in the low-proportion group(all P<0.05). The 28-day mortality was not significantly different among the three groups(13.8%, 8.33%, 3.56%, χ^(2)=1.543;P=0.462). Conclusion Early enteral parenteral combined nutrition can effectively improve the respiratory function, nutritional status and intestinal mucosal barrier dysfunction in patients with COPD and respiratory failure type Ⅱ, as well as the prognosis. The combined nutrition program with enteral parenteral nutrition calorie ratio of 3∶1 has the best effect.