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

潘丽娜; 徐蕾; 孟囡囡; 程玉婷

doi:10.16766/j.cnki.issn.1674-4152.002845

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

doi: 10.16766/j.cnki.issn.1674-4152.002845

1.
同济大学附属第十人民医院上海市第十人民医院呼吸与危重症医学科，上海 200072
2.
杨浦区中医医院肺病科，上海 200082

基金项目:

上海市卫生和计划生育委员会中医药科研项目 2018LP043

详细信息

通讯作者:
程玉婷，E-mail：foxdo456789@163.com

中图分类号: R563 R459.3
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出版历程
- 收稿日期: 2022-04-27
- 网络出版日期: 2023-04-20

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

1.
Department of Respiratory and Critical Care Medicine, the 10th People ' s Hospital of Tongji University, Shanghai 200072, China

摘要

摘要: 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PaCO₂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(χ²=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。
- 早期肠内营养 /
- 早期肠外营养 /
- 慢性阻塞性肺疾病 /
- Ⅱ型呼吸衰竭
Abstract: 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). PaCO₂ 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%, χ²=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.
- Early enteral nutrition /
- Early parenteral nutrition /
- Chronic obstructive pulmonary disease /
- Type Ⅱ respiratory failure

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表 1 3组COPD合并Ⅱ型呼吸衰竭患者一般临床资料比较

Table 1. Comparison of general clinical data of COPD combined with respiratory failure type Ⅱ in 3 groups

组别	例数	性别(例)		年龄 (x±s，岁)	COPD病程 (x±s，年)	APACHEⅡ评分 (x±s，分)
组别	例数	男性	女性	年龄 (x±s，岁)	COPD病程 (x±s，年)	APACHEⅡ评分 (x±s，分)
低比例组	36	19	17	62.57±5.73	7.52±1.35	33.85±2.76
中比例组	36	22	14	63.16±5.63	7.32±1.75	32.63±2.82
高比例组	36	23	13	62.43±5.62	7.69±1.67	33.16±2.78
统计量		0.997^a		0.169^b	0.483^b	1.735^b
P值		0.607		0.845	0.618	0.181
注：^a为χ²值，^b为F值。

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表 2 3组COPD合并Ⅱ型呼吸衰竭患者治疗前后呼吸指标比较(x±s)

Table 2. Comparison of respiratory indexes before and after treatment in patients with COPD combined with respiratory failure type Ⅱ in 3 groups (x±s)

组别	例数	PaO₂(mm Hg)		PaCO₂(mm Hg)		FEV₁(L)		FEV₁/FVC(%)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
低比例组	36	52.75±3.72	62.87±3.68^ab	73.46±5.62	58.62±3.46^ab	0.58±0.12	0.68±0.16^ab	48.53±2.46	58.69±3.73^ab
中比例组	36	52.85±3.68	63.69±3.73^ab	72.85±4.79	57.92±3.77^a	0.57±0.15	0.69±0.15^ab	48.79±2.53	59.22±3.69^ab
高比例组	36	52.58±2.86	65.83±4.89^a	73.78±5.73	56.49±3.85^a	0.58±0.13	0.76±0.13^a	47.97±2.83	61.57±3.98^a
F值		0.057	4.911	0.276	3.104	0.067	3.157	0.927	5.851
P值		0.945	0.009	0.759	0.049	0.935	0.047	0.399	0.004
注：与同组治疗前比较，^aP＜0.05；与高比例组治疗10 d后比较，^bP＜0.05。

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表 3 3组COPD合并Ⅱ型呼吸衰竭患者治疗前后营养指标比较(x±s)

Table 3. Comparison of nutritional indexes of patients with COPD combined with respiratory failure type Ⅱ before and after treatment in 3 groups (x±s)

组别	例数	ALB(g/L)		PA(mg/L)		TRF(mg/dL)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
低比例组	36	31.82±2.58	33.97±2.39^abc	258.37±13.53	301.36±18.42^abc	159.57±12.46	168.78±17.76^abc
中比例组	36	32.12±2.57	35.15±2.73^ab	259.31±15.64	323.47±16.83^ab	160.25±15.73	175.69±16.96^ab
高比例组	36	32.26±2.52	37.82±2.58^a	258.48±12.63	365.36±15.25^a	159.65±16.63	182.98±17.68^a
F值		0.278	21.199	0.049	133.449	0.022	5.947
P值		0.758	＜0.001	0.952	＜0.001	0.978	0.004
注：与同组治疗前比较，^aP＜0.05；与高比例组治疗10 d后比较，^bP＜0.05；与中比例组治疗10 d后比较，^cP＜0.05。

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表 4 3组COPD合并Ⅱ型呼吸衰竭患者治疗前后肠黏膜屏障功能比较(x±s)

Table 4. Comparison of intestinal mucosal barrier function in patients with COPD combined with respiratory failure type II before and after treatment in 3 groups (x±s)

组别	例数	D-乳酸(mg/L)		DAO(mg/L)		前降钙素(mg/dL)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
低比例组	36	9.30±1.46	8.02±0.43^ab	5.86±0.75	4.56±0.26^ab	9.68±1.67	6.88±0.87^ab
中比例组	36	9.38±1.52	8.15±0.42^ab	5.73±0.31	4.38±0.21^ab	9.37±1.56	6.52±0.86^ab
高比例组	36	9.73±1.63	7.08±0.67^a	5.75±0.45	3.15±0.25^a	9.83±1.81	4.57±0.69^a
F值		0.796	45.442	0.615	365.104	0.699	84.572
P值		0.454	＜0.001	0.543	＜0.001	0.499	＜0.001
注：与同组治疗前比较，^aP＜0.05；与高比例组治疗10 d后比较，^bP＜0.05。

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表 5 3组COPD合并Ⅱ型呼吸衰竭患者临床预后指标比较

Table 5. Comparison of clinical prognostic indexes in patients with COPD combined with respiratory failure type Ⅱ among 3 groups

组别	例数	机械通气时间(x±s，d)	ICU住院时间 (x±s，d)	总住院时间 (x±s，d)	胃肠道不耐受[例(%)]	28 d病死率 [例(%)]
低比例组	36	6.53±0.77^a	7.85±1.53^a	11.49±2.75^a	2(5.56)	5(13.89)
中比例组	36	6.15±0.93	7.42±1.65	10.78±2.82	2(5.56)	3(8.33)
高比例组	36	5.93±0.52	6.89±1.72	9.56±2.78	4(11.11)	2(5.56)
统计量		5.758^b	3.113^b	4.428^b	1.080^c	1.543^c
P值		0.004	0.049	0.014	0.583	0.462
注：与高比例组比较，^aP＜0.05。^b为F值，^c为χ²值。

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