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作 者:秦媛怡[1] 魏立平[1] 谢威[1] 黄东健[1]
机构地区:[1]广州医学院第三附属医院,广东广州510150
出 处:《河北医学》2010年第7期777-780,共4页Hebei Medicine
摘 要:目的:评价早期低热量肠内营养支持对COPD患者机械通气对代谢、机械通气时间,生存率等结局的影响。方法:前瞻性随机对照临床研究。符合入选标准的COPD合并呼吸衰竭需要气管插管机械通气患者38例,随机分为研究组和对照组。研究组:20例,肠内营养(EN)按非蛋白热量15-20kcal.(kg.d)-1,对照组:18例,按非蛋白热量30kcal.(kg.d)-1。两组患者均在机械通气24h内连续7d经鼻胃管管饲提供EN支持。观察两组血糖、白蛋白、氮平衡等营养指标,机械通气时间、生存率等情况。结果:研究组对EN的耐受性明显高于对照组;与对照组对比,研究组在大多数时间血糖基本正常率较高(89.3%vs 21.3%,P=0.000),每天排出氮量水平明显降低(P=0.000),氮平衡也明显占优;白蛋白、肌酐/身高指数(ICr)营养指数均占优、研究组机械通气时间(d)明显低于对照组(4.21±3.89 vs.10.31±5.11,P=0.0015);两组生存率无明显统计学差异(3.3%vs16.6%,P=0.0149)。结论:与传统EN比较,COPD机械通气后患者早期接受低热量肠内营养支持,有利于降低高血糖并发症及高代谢率、缩短机械通气时间,有临床实用意义。Objective:To evaluate the impact of hypocaloric enteral nutrition(EN) on metabolization,ventilation time and treatment in COPD patients with ventilation.Method: 38 patients with COPD with ventilation were randomly assigned into 2 groups: control group,18 cases,receiving EN with 30 kcal·(kg·d)-1,and study group,20 cases,receiving calorie of 15-20 kcal·(kg·d)-1.EN support was infused continuously for at least seven post-ventilation days through nose-gastide tube feeding.The blood glucose level,serum albumin level,nitrogen balance index,days of mechanical ventilation and survival rate were compared between these two groups.Result:Compared with those of control group,the ratio of patients with normal glucose level,the serum albumin level,ICr were significantly higher in study group(P0.05,respectively);while the nitrogen discharge everyday,days of mechanical ventilation were significantly lower in study group(P0.05,respectively).And the two groups presented no statistical difference(3.3% vs 16.6%,P=0.0149).Conclusion: Early hypocaloric EN in post-ventilation days in patients decreases the rates of hyperglycemia,and hypermetablism,shortens the ventilation time.
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