高脂低糖肠内营养对COPD机械通气患者临床疗效的影响

Therapeutic effects of high fat and low carbohydrate enteral nutrition in patients with chronic obstructive pulmonary disease under mechanical ventilation

目的 观察高脂低糖肠内营养(EN)对慢性阻塞性肺疾病(COPD)机械通气(MV)患者临床疗效的影响.方法 将2014年5月至2017年7月诸暨市中医院重症医学科收治的56例COPD行MV患者按随机数字表法分为试验组(高脂低糖组,28例)和对照组(高糖低脂组,28例),分别采用高脂低糖和高糖低脂EN饮食治疗2周后,比较两组患者pH值、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、每分通气量(VE)、氧耗量(VO2)、二氧化碳生成量(VCO2)、外周血总淋巴细胞计数(TLC)、免疫球蛋白(IgA、IgG、IgM)、MV时间、脱机成功率及生存率的差异.结果 治疗2周后,试验组PaCO2、PaO2、VCO2、VO2、VE、TLC均较对照组明显改善〔PaCO2(mmHg,1 mmHg=0.133 kPa):48.37±10.22比55.34±9.87,PaO2(mmHg):73.45±14.68比67.43±7.38,VCO2(mL):264±22比287±30,VO2(mL):316±35比344±22,VE(L/min):10.0±1.6比11.6±1.9,TLC(×109/L):1.62±0.73比1.21±0.21,均P<0.05〕,MV时间较对照组明显缩短(d:6.89±1.15比8.78±1.29),脱机成功率及生存率均较对照组明显提高〔脱机成功率:67.9%(19/28)比42.9%(12/28),生存率:89.3%(25/28)比78.6%(22/28),均P<0.05〕.结论 高脂低糖EN能改善COPD行MV患者通气指标和免疫功能指标,缩短MV时间,提高患者脱机成功率及生存率.

Objective To observe the clinical effect of high fat and low carbohydrate enteral nutrition (EN) for treatment of patients with chronic obstructive pulmonary disease (COPD) under mechanical ventilation (MV). Methods Fifty-six COPD patients with MV admitted to the Department of Intensive Care Unit of Traditional Chinese Medicine Hospital of Zhuji from May 2014 to July 2017 were enrolled, and they were randomly divided into an experimental group administered with high fat and low carbohydrate EN (28 cases) and a control group administered with high carbohydrate and low fat EN (28 cases ), the therapeutic course being two weeks in both groups. After two weeks of treatment, the pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2), every minute ventilation volume (VE), oxygen consumption volume (VO2), carbon dioxide production volume (VCO2), total peripheral blood lymphocyte count (TLC), immunoglobulins (IgA, IgG, IgM), MV time, weaning success rate and survival rate were detected and compared between the two groups. Results Two weeks after nutritional support treatment, PaCO2, PaO2, VCO2, VO2, VE, TLC were all significantly improved in experimental group compared with those in control group [PaCO2(mmHg, 1 mmHg = 0.133 kPa): 48.37±10.22 vs. 55.34±9.87, PaO2(mmHg): 73.45±14.68 vs. 67.43±7.38, VCO2(mL): 264±22 vs. 287±30, VO2(mL): 316±35 vs. 344±22, VE (L/min): 10.0±1.6 vs. 11.6±1.9, TLC (×109/L): 1.62±0.73 vs. 1.21±0.21, all P < 0.05], MV time was significantly shorter in experiment group than that in control group (days: 6.89±1.15 vs. 8.78±1.29), weaning success rate and survival rate were significantly higher in experiment group than those in control group (weaning success rate: 67.9% (19/28) vs. 42.9% (12/28), survival rate:89.3% (25/28) vs. 78.6% (22/28), both P < 0.05)Conclusion High fat and low carbohydrate EN can improve the ventilation and immune indexes in COPD patients with MV, shorten the MV time and increase the weaning success rate and survival rate.