慢性阻塞性肺疾病患者营养状况对呼吸机撤离的影响  

Effects of the nutritional status on weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease

作　　者：高小芳[1] 朱晓萍[2] 曹相原[2] 马希刚[2] 杨晓军[2] 

机构地区：[1]宁夏自治区人民医院,宁夏银川750021 [2]宁夏医科大学附属医院,宁夏银川750004

出　　处：《宁夏医学杂志》2011年第5期390-393,共4页Ningxia Medical Journal

摘　　要：目的研究慢性阻塞性肺疾病(COPD)行机械通气(MV)患者的营养状况及血清瘦素水平对呼吸机撤离的影响。方法 33例行机械通气的COPD住院男性患者,于停机前分别进行营养状况参数及血清瘦素(Lep-tin)水平测定。营养参数包括:肱三头肌皮褶厚度(TSF)、上臂肌围长(MAMC)、血清白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF)、总淋巴细胞计数(TLC)。根据撤机结果,将停机后48 h内无需重新插管带机者纳入撤机成功组,否则为撤机失败组。结果①COPD撤机失败组的营养参数TSF、MAMC、ALB、PA、TRF、TLC明显差于撤机成功组(P<0.05);血清瘦素水平也明显低于撤机成功组(P<0.05);②33例患者的撤机成功率为66.7%,营养不良的发生率为60.6%;营养不良者的撤机成功率为50.0%,而营养正常者的撤机成功率为92.7%,营养正常者的撤机成功率高于营养不良者(P<0.05);③营养参数以正常参考值的90%为界,将所有可能相关的测量指标进行单因素分析发现,有3项指标TSF<7.5mm(OR=9.643,P<0.01)、MAMC<22.5cm(OR=7.875,P<0.05)、PA<0.16g/L(OR=2.100,P<0.05)为撤机失败的危险因素,差异有统计学意义。结论 COPD撤机失败者的营养状况及血清瘦素水平差于撤机成功者,而且营养正常患者撤机成功率高于营养不良者,推测营养状况及血清瘦素水平可能是影响撤机结果的因素之一。Objective To assess the nutritional status and the level of serum leptin in order to explore the effects of them on weaning in chronic obstructive pulmonary disease（COPD） patients with ventilator.Methods According to the result of weaning,thirty-three male patients with COPD who did not require mechanical ventilation again after withdrawing mechanical ventilator longer than 48 hours were divided into successful group,otherwise were unsuccessful group.Nutrition parameters including triceps skin-fold thickness（TSF）,mid-upper arm muscle circumference（MAMC）,albumin（ALB）,prealbumin（PA）,transferring（TRF）,total lymphocytes count（TLC） and serum leptin were determined.Results Nutrition parameters were significantly lower in unsuccessful patients than those in successful patients,including TSF,MAMC,ALB,PA,TRF,TLC and leptin（P〈0.05）.33 COPD patients,the ratio of successful weaning were 66.7%.60.6% of patients were malnutrition.The successful weaning of malnutritional patients were 50.0%,but in the normal nutrition patients,the ratio were 92.3%.The successful weaning ratio is lower in malnutrition patients than that in normal nutrition patients,the difference was significantly（P〈0.05）.All measured parameters were analyzed by one-way analysis,3 factors TSF7.5 mm（OR=9.643,P〈0.01）,MAMC22.5cm（OR=7.875,P〈0.05）,PA0.16g/L（OR=2.100,P〈0.05） were risk factors of unsuccessful weaning with COPD.Conclusion The nutritional state and serum leptin levels were lower in unsuccessful group than the successful group.The ratio of successful weaning is higher in normal nutrition patients than that in malnutrition patients.We presume the nutritional state is one effective factor of unsuccessful weaning.

关 键 词：慢性阻塞性肺疾病 撤机 瘦素 营养状况 

分 类 号：R563.9[医药卫生—呼吸系统]