慢性阻塞性肺疾病机械通气患者早期肠内营养的疗效观察  

Clinical Application of Early Enteral Nutrition in the Patients of Chronic Obstructive Pulmonary Disease with Mechanical Ventilation

作　　者：翟哲[1] 高岩[1] 毕宏远[1] 王鹏[1] 刘小伟[1] 

机构地区：[1]哈尔滨医科大学附属第四医院重症医学科,黑龙江哈尔滨150001

出　　处：《现代生物医学进展》2012年第28期5552-5554,5561,共4页Progress in Modern Biomedicine

摘　　要：目的:评价早期肠内营养(EEN)对慢性阻塞性肺疾病(COPD)机械通气患者的疗效。方法:选择COPD合并呼吸衰竭行机械通气患者60例,分为两组:分别给予相同热量及氮量,EEN组30例,接受早期肠内营养治疗,按照肠内营养优化策略喂养;对照组接受肠内营养联合肠外营养(EN+PN)30例,接受常规营养治疗。观察两组治疗前后营养指标,机械通气时间、1周平均营养费用、呼吸机相关性肺炎(VAP)发生率。监测治疗前后两组血清总蛋白、前白蛋白和血红蛋白水平及免疫指标T细胞亚群。结果:EEN组病人治疗后一周血清白蛋白水平及免疫指标均明显升高,且均高于对照组治疗后水平(P<0.05)。机械通气时间、平均营养费用、VAP发生率明显低于对照组(P<0.05)。结论:优化管理的早期肠内营养治疗费用低,能改善COPD机械通气患者的营养状况、缩短机械通气时间,减少VAP发生率。只要胃肠道有功能,就应尽早实施肠内营养。Objective： To explore the effect of early enteral nutrition （EEN） in the patients of chronic obstructive pulmonary dis- ease with mechanical ventilation. Methods： 60 patients of chronic obstructive pulmonary disease and repiratory failure with mechanical ventilation were divided into experimental group（EEN） （n=30） and control group （n=30）. The experimental group received early enteral nutrition and the control group received the regular clinical therapy（EN＋PN）. The mechanical ventilation time, occurrence rate of ventila- tor-associated pneumonia （VAP） and nutrition costs in one week, were compared between the two groups. The levels of serumtotal pro- tein, prealbumin hematoglobulin and T cell subset indexes in the period of treatment were examined in two groups. Results： In the ENN group, prealbumins and T cell subset indexes increased obviously than those before therapy or those in control group at same stage. （P〈 0.05, respectively）. The mechanical ventilation time,occurrence rate of pneumonia associated with ventilation（VAP） and nutrition costs in one week, in EEN group were significantly higher thanthat in the control group（P〈0.05）. Conclusions： Early enteral nutrition optimization strategy costs less and may obviously improve the nutrition parameters of chronic obstructive pulmonary disease with mechanical ventila- tion, shorten the mechanical ventilation time, reduce the occurrence rate of ventilator-associated pneumonia. When the gut works, and can be used safely, use it early.

关 键 词：慢性阻塞性肺疾病 机械通气 早期肠内营养 

分 类 号：R563[医药卫生—呼吸系统]