早期肠内营养支持对有创机械通气COPD患者肺康复的疗效评价

Evaluation of the efficacy of early enteral nutrition support on pulmonary rehabilitation in COPD patients with invasive mechanical ventilation

目的探讨早期肠内营养支持(EEN)对ICU有创机械通气COPD患者肺康复的疗效评价。方法选取2017年7月—2019年7月医院ICU收治的实施肺康复的有创机械通气COPD患者70例作为研究对象,按照组间基本特征具有可比性的原则分成观察组与对照组,各35例。对照组实施有创机械通气、肺康复、抗感染、肠外营养等常规对症治疗。观察组在对照组基础上,予以24 h内开启肠内营养支持疗法。比较两组血清白蛋白、血红蛋白、APACHEⅡ评分、NRS评分、英国医学研究委员会(MRC)肌力、机械通气时间、ICU治疗时间、胃肠道并发症情况。结果肠内营养干预前,两组患者血清白蛋白与血红蛋白水平、APACHEⅡ和NRS2002评分、MRC肌力评分的比较,差异无统计学意义(P>0.05);肠内营养干预7 d后,两组血清白蛋白与血红蛋白水平、MRC肌力评分均较护理干预前升高,且观察组高于对照组,差异有统计学意义(P<0.05)。两组APACHEⅡ评分、NRS2002评分均降低,但观察组低于对照组,差异有统计学意义(P<0.05)。观察组机械通气时间、ICU治疗时间均短于对照组(P<0.05),两组胃肠道并发症发生率比较差异无统计学意义(P>0.05)。结论早期肠内营养支持可有效提高有创机械通气COPD患者的肌力,改善营养不足,缩短机械通气时间、ICU治疗时间,使患者尽早撤机,提高了康复效果。

Objective To investigate the efficacy evaluation of Early Enteral Nutrition support(EEN)on the pulmonary rehabilitation of patients with invasive mechanically ventilated COPD in ICU.Methods 70 patients with invasive mechanically ventilated COPD admitted to the ICU of the hospital from July 2017 to July 2019 who underwent pulmonary rehabilitation were selected as the study subjects,they were divided into 35 cases each in the observation group and the control group according to the principle of comparability of basic characteristics between groups.In the control group,invasive mechanical ventilation,pulmonary rehabilitation,anti-infection,parenteral nutrition and other conventional symptomatic treatments were administered.In the observation group,on the basis of control group,enteral nutrition support therapy was started within 24 h.Serum albumin,haemoglobin,APACHE II score,NRS score,the UK Medical Research Council(MRC)muscle strength,duration of mechanical ventilation,ICU treatment time and gastrointestinal complications were compared between the two groups.Results Before the enteral nutrition intervention,the differences in serum albumin and haemoglobin levels,APACHE II and NRS2002 scores,and MRC muscle strength scores between the two groups were not statistically significant(P>0.05);After 7 d of enteral nutrition intervention,the serum albumin and haemoglobin levels and MRC muscle strength scores in both groups increased,and compared with those before the nursing intervention,and the difference was higher in the observation group than in the control group,the difference was statistically significant(P<0.05).The APACHE II score and NRS2002 score decreased in both groups,but the difference was statistically significant(P<0.05),with the observation group had a lower score than the control group.The duration of mechanical ventilation and ICU treatment time were shorter in the observation group than in the control group(P<0.05),there was no statistically significant difference in the incidence of gastrointestinal complications between the two groups(P>0.05).Conclusion Early enteral nutrition support could effectively improve the muscle strength of patients with invasive mechanical ventilation COPD,improve the nutritional deficiency,shorten the time of mechanical ventilation and ICU treatment,enable patients to be withdrawn from the machine as early as possible,and improve the rehabilitation effect.