慢性阻塞性肺病患者机械通气期间营养支持的方法与时机

To select the way and chance of nutritional support in COPD patients with mechanical ventilation

目的探讨慢性阻塞性肺病患者机械通气期间营养支持的方法与时机。方法19例慢性阻塞性肺病患者在机械通气24小时内予静脉营养,24小时后逐步加用肠内营养,观察有无腹泻、腹胀、腹痛、胃肠出血、二重感染及食管反流,监测肝肾功能、血糖、血清总蛋白、血清白蛋白、胆红素、血脂、动脉血气分析、血电解质水平。结果19例患者中7例在脱机前顺利完成了静脉营养向肠内营养的转换,4例因消化道出血或严重腹泻、肠麻痹而在脱机前无法应用肠内营养,持续静脉营养支持,8例在脱机前应用肠内营养+静脉营养方法。结论在生命体征平稳、感染控制、呼吸衰竭纠正的前提下应积极由静脉营养过渡到肠内营养,以减少并发症的发生。

Objective To discuss the way and chance of nutrition support in ch ronical obstructive pulmonary disease (COPD) patients with mechanical ventilatio n. Methods 19 patients with COPD use parenteral nutrition (PN) in 24 hours after mechanical ventilation, add enteral nutrition (EN) gradually after 24 hours. Di arrhea, abdominal distension, abdominal pain, hemorrhage of gastrointestinal tra ct, secondary infection and reflux of the esophagitis were observed, the functio n of kidney and the levels of blood glucose, serum total protein, serum albumin, serum bilirubin, blood lipoids, arterial blood gas analysis, serum electrolyte were mensurated. Results In the 19 cases, before mechanical ventilation was stop ped, 7 cases changed PN to EN successfully, 4 cases could not use EN because of hemorrhage of gastrointestinal tract or severity diarrhea or intestinal paralysi s, PN had to be used only. Both PN and EN were used in the other 8 cases. Conclu sions If vital signs were steady, the infection had been controlled and the resp iratory failure had been remedied, the change from PN to EN should be taken step by step actively, so the complication could be reduced.